Journal of Eye Diseases and Disorders

Exploring the Impact of Vitrectomy on Vitrectomy for Rhegmatogenous Detachment

Sabbaghi Elsayed^* Department of Ocular Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
^*Correspondence: Sabbaghi Elsayed, Department of Ocular Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, Email:

Received: 11-Mar-2024, Manuscript No. JEDD-24-25171; Editor assigned: 13-Mar-2024, Pre QC No. JEDD-24-25171 (PQ); Reviewed: 27-Mar-2024, QC No. JEDD-24-25171; Revised: 03-Apr-2024, Manuscript No. JEDD-24-25171 (R); Published: 10-Apr-2024, DOI: 10.35248/2684-1622.23.8.235

Description

Rhegmatogenous Retinal Detachment (RRD) is a sight-threatening condition characterized by the separation of the neurosensory retina from the underlying Retinal Pigment Epithelium (RPE) due to the presence of retinal breaks or tears. While pneumatic retinopexy and scleral buckling have traditionally been employed as primary treatment modalities for RRD, vitrectomy has emerged as a highly effective surgical intervention for achieving retinal reattachment and restoring visual function. In this article, we delve into the principles of vitrectomy for RRD, its indications, techniques, outcomes, and advancements.

RRD occurs when liquefied vitreous humor gains access to the sub retinal space through a retinal break or tear, leading to the formation of a retinal detachment. This process often occurs in the setting of Posterior Vitreous Detachment (PVD), where the separation of the vitreous gel from the retina predisposes to the development of retinal breaks, particularly at the vitreoretinal interface. The primary risk factors for RRD include myopia, trauma, lattice degeneration, previous cataract surgery, and genetic predisposition. Patients with RRD typically present with symptoms such as flashes of light, floaters, and a sudden onset of visual field defects, which may progress to a curtain-like shadow or loss of vision if left untreated. Vitrectomy eliminates vitreous traction on the retina, reducing the risk of further retinal breaks or progression of detachment. Vitrectomy allows for direct visualization and closure of retinal breaks using techniques such as endolaser photocoagulation or cryotherapy. Vitrectomy facilitates the injection of intraocular tamponade agents, such as gas or silicone oil, to support retinal reattachment and promote healing of retinal breaks. Vitrectomy may be preferred for cases of RRD involving large or extensive retinal detachments, particularly those associated with Proliferative Vitreoretinopathy (PVR) or tractional elements. Vitrectomy allows for precise identification and closure of multiple or posteriorly located retinal breaks, which may be challenging to treat with conventional methods.

Vitrectomy is often indicated for cases of RRD that have failed previous attempts at pneumatic retinopexy or scleral buckling, as well as for recurrent detachments following initial repair. Vitrectomy may be necessary in cases of RRD associated with other vitreoretinal pathology, such as macular holes, epiretinal membranes, or vitreomacular traction. Small gauge (23 gauge -25 gauge) pars plana incisions are created to allow entry of the vitrectomy instruments into the eye while minimizing trauma to the ocular tissues.

The central vitreous gel is removed using a vitrectomy probe, starting from the posterior pole and extending peripherally to the retinal periphery. Any epiretinal membranes or vitreoretinal adhesions contributing to retinal traction are dissected and removed using microsurgical instruments. Retinal breaks are identified and treated with endolaser photocoagulation or cryotherapy to achieve permanent chorioretinal adhesion and prevent fluid entry into the subretinal space. A gas bubble or silicone oil is injected into the vitreous cavity to tamponade the retina and maintain apposition of the neurosensory retina to the RPE.

The sclerotomy wounds are closed using sutures or a self-sealing mechanism to maintain intraocular pressure and prevent postoperative hypotony. Vitrectomy for RRD has demonstrated excellent anatomical and functional outcomes, with success rates exceeding 80%-90% in many studies. Successful retinal reattachment is typically achieved within weeks to months following surgery, with improvement in visual acuity observed in a majority of patients. Posterior subcapsular cataract formation is a common complication following vitrectomy, necessitating subsequent cataract surgery in a significant proportion of patients. Transient intraocular pressure elevations or fluctuations may occur following vitrectomy, particularly in eyes with preexisting glaucoma or compromised outflow pathways. Endophthalmitis, though rare, is a serious complication of vitrectomy that requires prompt recognition and aggressive treatment with intravitreal antibiotics. Proliferative Vitreoretinopathy (PVR) remains a leading cause of surgical failure and recurrent RRD following vitrectomy, necessitating additional surgical interventions or adjunctive therapies.

Recent advancements in vitrectomy technology have further enhanced the safety, efficiency, and precision of surgical techniques for RRD repair. Microincisional Vitrectomy Surgery (MIVS) is the introduction of smaller gauge vitrectomy probes and instrumentation has facilitated the transition to microincisional vitrectomy surgery, offering reduced surgical trauma, faster postoperative recovery, and improved patient comfort. High-resolution wide-angle viewing systems, such as panoramic viewing lenses and heads-up display systems, provide enhanced visualization of the vitreous cavity and peripheral retina, improving surgical outcomes and reducing the risk of missed retinal pathology.