[Role of segmental buckling surgery in treatment of stages B and C proliferative vitreoretinopathy detachment. A long-term follow-up].

BACKGROUND

The following questions should be addressed: (1) Is minimal detachment surgery justified in treating detachments with preoperative PVR stage B or C? (2) Can this reattach the retina with stabilization or regression of PVR?

MATERIALS AND METHODS

72 PVR detachments stage B or C (38 C1, 11 C2, 1 C3) were treated by cryopexy, segmental buckling (n = 68) or balloon (n = 4) without drainage or vitrectomy. Reoperation (n = 10) was done without cerclage or vitrectomy. The follow-up of patients alive is 11 to 13 1/2 years and of all patients (31 died) x 7 1/2 years.

RESULTS

After the primary operation the retina was reattached in 79%, partially in 15% and detached in 6%. An "early" redetachment (< or = 6 months postoperatively) occurred in 8.3%, no redetachment > 6 months to < 9 years and "late" redetachment (9-13 1/2 years postoperatively) in 2.8%. After reoperation (n = 10) the retina was reattached in 85%, partially in 3%, and detached in 12%. 34 eyes had delayed resorption (2 weeks to 18 months) with a residual concave detachment in area of starfolds and tractions, resulting in dry starfolds or their disappearance after months. Postoperatively there were no rubeosis iridis, no secondary glaucoma and no phthisis bulbi. Subsequent macular pucker developed in 12 eyes, which were not treated by vitreoretinal surgery. Six months postoperatively visual acuity was: 26x 20/60-20/25; 16x 20/200-20/100; 30x < or = 20/400 which was not statistically significant different (p = 0.549) after x 7 1/2 years.

CONCLUSION

Primary treatment of a PVR detachment stage B or C1/C2 with cryopexy and segmental buckling and nondrainage seems justified to test for the chance of PVR-regression. The retina was reattached in 8 of 10 patients x 7 1/2 years postoperatively after primary operation without reoperation or vitrectomy and visual acuity was 20/60-20/25 in every third patient, thus implying a lack of late serious complications.