Recurrences of retinal detachment after vitreoretinal surgery, and surgical approach.

PURPOSE: To investigate the causes and management of recurrences of complicated retinal detachment after vitreoretinal surgery. METHODS: Vitreoretinal surgery was performed in 61 patients with complicated retinal detachment who were followed up for 4-24 (mean 7) months. Liquid perfluorocarbon (PFC) was used in all 61, silicone oil in 40 and perfluoropropane (C3F8) in 18 patients. RESULTS: Retinal attachment was achieved in 58 patients (95%) during the first operation. Due to the recurrence of detachment 17 patients (29%) had to be operated for a second, 7 (12%) a third and 4 (7%) a fourth time. Anterior and posterior proliferative vitreoretinopathy, missed tear, retinal incarceration, subretinal membrane and perisilicone proliferation were the factors causing redetachment. CONCLUSIONS: The best anatomical and functional results are obtained by dissection of the anterior membranes. In order to properly remove the retinal periphery the crystalline or intraocular lens should be removed. Comparison of our results with others indicates that anatomical success depends, to a certain extent, on doing only one, radical operation on the pathology that leads to recurrence.

Diode laser transscleral retinopexy in rhegmatogenous retinal detachment surgery.

PURPOSE: To evaluate the safety and efficacy of transscleral diode laser for retinopexy in rhegmatogenous retinal detachment surgery. METHODS: Conventional retinal detachment surgery with transscleral diode laser retinopexy was performed on 52 eyes of 52 patients (22 female, 30 male), aged from 12 to 74 years (mean 51 + 4.1). RESULTS: Of the 52 eyes 36 (69%) were reattached in a single operation and adequate chorioretinal scars were achieved in 34 of them. Additional transpupillary laser photocoagulation was performed in two cases in the postoperative period. Retinal re-attachment was achieved with exoplant revision and transscleral laser retinopexy in six cases (12%). Ten cases (19%) with severe PVR were reattached with vitreoretinal surgery. CONCLUSIONS: Transscleral diode laser retinopexy was an effective and safe method, with accurate lesion location, concurrent permanent laser marks on the retina, and easy transmission through the extraocular muscles and solid buckling elements. Minor complications were minimized by gaining experience with the technique.