Recurrent rhegmatogenous retinal detachment after primary vitrectomy by surgeons in training - incidence and predictive factors.

PURPOSE

To evaluate the success rate of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) by inexperienced vitreoretinal (VR) surgeons in training and to analyze the predictive factors for retinal re-detachment in this group of surgeons.

METHODS

We reviewed the records of the first 150 primary vitrectomies for RRD, with routine use of triamcinolone, performed by three VR surgeons, who began their VR careers in our Department of Ophthalmology. The primary endpoint was the re-detachment rate after single procedure. Subsequently, the baseline clinical and demographic characteristics of patients who developed retinal re-detachment were compared with those of the remaining patients to identify factors that may predict retinal re-detachment in this group of surgeons.

RESULTS

Overall, the primary re-detachment rate after a single surgery and a minimum follow-up of six months was 16.7% (25 out of 150 cases). Patients with re-detachment had a significantly higher rate of total RRD (19% vs. 36%, p = 0.004), a higher rate of grade C proliferative vitreoretinopathy (25% vs. 36%, p = 0.04) and received lesser intraoperative endo-laser cerclage (42% vs. 92%, p < 0.001). Other characteristics including gender, age, side of the eye, duration of symptoms, presence of myopia, macular status, lens status, location of tear, performance of retinotomies, the different types of tamponade and the performance of simultaneous phacoemulsification showed no statistically significant difference.

CONCLUSION

Our inexperienced VR surgeons have a primary success rate of 83.3% for their first 150 RRD surgeries. Patients with total RRD and PVR grade C should be avoided by VR surgeons in training. It may also be advisable to perform an endo-laser cerclage during the training period.