Pars Plana Vitrectomy Alone for the Management of Inferior Breaks in Pseudophakic Retinal Detachment Without Facedown Position

Objective: To introduce a new approach with pars plana vitrectomy (PPV) alone and no facedown positioning in the management of pseudophakic retinal detachments (RDs) with inferior breaks.

Design: Prospective noncomparative interventional case series.

Participants: Forty consecutive pseudophakic eyes of 40 patients with rhegmatogenous RD with causative inferior breaks. INTERVENTION OR METHODS: All eyes underwent PPV alone, with air as tamponade and with no facedown position in the postoperative period. The supine position was used in some cases for 30 minutes.

Main Outcome Measures: Postoperative primary and final anatomical outcome, visual acuity (VA), and complications.

Results: Patients were observed for a minimum of 7 months (mean, 11.7). Primary retinal reattachment was obtained in 36 of 40 patients (90%). Final reattachment was obtained in 40 of 40 patients (100%). One patient (2.5%) developed proliferative vitreoretinopathy at the sixth week after surgery. Three patients (7.5%) redetached, presumably due to untreated breaks. Two patients (5%) developed a macular epiretinal membrane that required surgery. Mean preoperative best-corrected VA (BCVA) was 20/63 (range, hand movements [HM] to 20/20). Mean final BCVA was 20/33 (range, 20/200-20/20). Of the 16 eyes with a macula-attached rhegmatogenous RD, mean preoperative BCVA was 20/29 (range, 20/100-20/20). Mean postoperative BCVA was 20/30 (range, 20/60-20/20). Of the 24 eyes with macula-detached RDs, mean preoperative BCVA was 20/300 (range, HM to 20/40). Mean postoperative BCVA was 20/36 (range, 20/200-20/20). Visual acuity of 20/40 or better was seen in 17 of 24 eyes (70.8%).

Conclusions: This pilot study provides evidence that the facedown posture after PPV is not necessary to achieve retinal reattachment in pseudophakic RD with inferior breaks.