Relaxing retinotomies and retinectomies in the management of retinal detachment with severe proliferative vitreoretinopathy (PVR)

Khaled AG Shalaby
Opthamology Department, Al-Azhar University, Cairo, Egypt; Chief Vitreoretinal Service, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

Abstract: Relaxing retinotomies and retinectomies are used in the presence of retinal shortening resulting from retinal incarceration or fibrous proliferation and contraction that prevents contact of the retina with the retinal pigment epithelium. The peripheral retina is usually cut or excised to preserve function of the posterior retina which is more visually significant.
Objective: To investigate the techniques, therapeutic effects, indications, and complications of relaxing retinotomies and retinectomies for complicated retinal detachment with severe proliferative vitreoretinopathy (PVR).
Methods: Thirty eight eyes of 38 patients of complicated retinal detachment with severe PVR were recruited for a noncomparative retrospective study. They were operated on and followed-up for at least six months. The operative technique included buckling, vitrectomy, peeling, relaxing retinotomy and/or retinectomy, intraocular tamponade, and laser treatment.
Results: Retina was reattached in 34 (89.5%) eyes in operations. Retinal detachment was recurrent in seven eyes in follow-up, in which the retina was reattached again in two eyes by a second operation. The final success rate was 76.3% (29 eyes out of 38 eyes). Visual acuity was perception of light with bad projection in 35 (92%) eyes and hand motion in three (8%) eyes before operation. Visual acuity was better than 4/60 in 23 eyes (60.5%) after operation. The complications included iatrogenic retinal breaks, bleeding from the retinotomy site, hypotony, and recurrent fibrous proliferation from the retinotomy site.
Conclusion: Retinotomy and retinectomy can improve the curative effect of complicated retinal detachment. There are potentially serious complications of these maneuvers and they should not be performed if less aggressive measures will suffice.
Keywords: relaxing retinotomy, retinectomy, proliferative vitreoretinopathy, recurrent retinal detachment, iatrogenic retinal breaks, intraoperative hemorrhage, intraocular tamponade, hypotony