Author: Leonid Kryl (Russian Federation)
Co-authors: Mariiam Taevere, Alexander Doga, Dmitriy Shkvorchenko
In previous studies, we proved that preliminary YAG-laser retinotomy of the horseshoe tear area with vitreoretinal adhesion (VRA) significantly increases the efficacy of pneumatic retinopexy (PnR) in the treatment of rhegmatogenous retinal detachment. The aim of the study is to evaluate the single operation success rate (primary anatomical success) and functional outcomes of radial scleral buckling (SB) versus pneumatic retinopexy with preliminary YAG-laser retinotomy.
S. Fyodorov Eye Microsurgery Federal State Institution, 59а, Beskoudnikovsky blvd, Moscow, 127486, Russian Federation.
The current study was a prospective randomized clinical trial. 84 eyes from 84 patients with macula-on RRD were included in this study. The patients were randomly allocated into a treatment group (43 patients who undergo PnR with preliminary retinotomy) and control group (41 patients who undergo SB). All patients of the treatment group underwent wide-field optical coherence tomography (Spectralis HRA+OCT; Heidelberg Engineering Inc., Germany) to determine the length and localization of VRA. The obtained data were used to perform YAG-laser retinotomy (Ultra Q Reflex; Ellex Inc., Australia). After YAG-laser retinotomy (on the same day), 12% C3F8 was injected. The final step of surgical treatment was laser photocoagulation (LPC) around the peripheral retinal hole after retinal attachment (2-3 days after pneumatic retinopexy). The follow-up was 3,6,12,18,24 month after treatment. We compared uncorrected (UCVA) and best corrected (BCVA) visual acuity, intraocular pressure (IOP), corneal astigmatism, the spherical component of the refraction and axis.
The single operation success rate in the control group was 95% and 93% in the treatment group. Two years after treatment the stable anatomical result in the control group was 85 % and 86% in the treatment group. Comparative analysis of functional outcomes revealed the absence of statistically significant changes after surgery in patients undergoing pneumatic retinopexy with preliminary YAG-laser retinotomy and in patients after SB - statistically significant changes in UCVA, cylindrical and spherical components of refraction.
Preliminary YAG-laser retinotomy in the horseshoe tear area in patients with macula-on RRD allows to relieve vitreoretinal traction and increase anatomical efficacy of treatment. Combined laser surgical treatment (YAG-laser retinotomy + PnR + LPC) showed the same single operation success rate and significantly higher functional outcomes compared to SB.