Primary Vitrectomy without Scleral Buckling for Pseudophakic Rhegmatogenous Retinal Detachment EFSTRATIOS MENDRINOS, NATHALIE P. DANG-BURGENER, ALEXANDROS N. STANGOS, JORG SOMMERHALDER, AND CONSTANTIN J. POURNARAS ● PURPOSE: To report the anatomic and functional re- sults of primary vitrectomy without scleral buckling for the treatment of pseudophakic rhegmatogenous retinal detachment (PsRD). ● DESIGN: Prospective, nonrandomized surgical tech- nique study. ● METHODS: One hundred eyes of 98 patients with PsRD were operated by vitrectomy alone. Internal sub- retinal fluid drainage, cryocoagulation and/or endolaser and fluid–air exchange with sulfur hexafluoride 20% was applied in all cases. The preoperative and postoperative characteristics were analyzed. Main outcome measures were anatomic success rates after initial surgical inter- vention and after reoperation for primary failures, visual outcome at the last follow-up visit, and complications. ● RESULTS: Mean follow-up  standard deviation (SD) was 12  6.3 months (range, seven to 36 months). Mean final visual acuity  SD was 0.42  0.45 logarithm of the minimum angle of resolution (logMAR) compared with 0.95  0.73 logMAR before surgery (P < .01). Mean number  SD of retinal breaks found before surgery was 1.36  1.12 (range, zero to five), and an additional 1.58  2.26 (range, zero to 15) retinal breaks were found during surgery. The retina was reattached successfully after a single surgery in 92 eyes (92%). Recurrence of retinal detachment occurred in eight eyes (8%), caused by proliferative vitreoretinopathy in six eyes (75%) and by new breaks in two eyes (25%). Final anatomic reattachment was obtained in these cases after a mean of 1.75 subsequent operations. Three eyes re- quired permanent silicone oil tamponade so that final anatomic success was achieved in 97 eyes (97%). The most common postoperative complication was ocular hypertonia of more than 21 mm Hg, observed in 36 (36%) eyes, which was managed successfully. ● CONCLUSIONS: Primary vitrectomy without scleral buckling provides a high anatomic success rate in eyes with PsRD and is associated with few complications. (Am J Ophthalmol 2008;145:1063–1070. © 2008 by Elsevier Inc. All rights reserved.) T HE INCIDENCE OF PSEUDOPHAKIC RHEGMATOG- enous retinal detachment (PsRD) has been esti- mated to range between 0.6% to 1.7% during the first year after cataract surgery and accounts for 30% to 40% of all rhegmatogenous retinal detachments (RDs). 1 Moreover, with the increasing popularity of cataract surgery and intraocular lens (IOL) implantation in association with increased life expectancy, it is likely that PsRD will represent an increasing proportion of rhegmatogenous RDs in coming years. Since the first series of patients reported by Tassman and Annesley on the management of PsRD, its treatment has represented a challenge for vitreoretinal surgeons. 2 Differ- ent surgical techniques have been used to manage PsRD, including pneumatic retinopexy, scleral buckling, and primary pars plana vitrectomy (PPV) with or without scleral buckling. Benson and associates published the results of a survey performed in 1997 by members of the Retina and Vitreous Societies from the United States of America and Canada. They found that 384 (62%) of surgeons preferred scleral buckling procedures to treat PsRD, 185 (30%) preferred pneumatic retinopexy, seven (1%) preferred using the Lincoff balloon, and only 44 (7%) preferred primary vitrectomy. 3 Because of the diffi- culties in visualization of retinal breaks in PsRD, many vitreoretinal surgeons are now using PPV with or without scleral buckling in the surgical repair of rhegmatogenous detachment in pseudophakic patients. 4 –12 Recent ad- vances in the vitrectomy technique and instrumentation have also contributed to the expanding role of PPV as a first-line surgical treatment in cases of PsRD. 13 We previously conducted a prospective study comparing primary PPV alone vs PPV with an encircling scleral buckling procedure and found no benefit of the additional buckling procedure. 14,15 Since then, we have been treating PsRD with PPV alone. We report herein our experience on primary vitrectomy without scleral buckling for the treat- ment of PsRD in terms of anatomic and visual results and associated complications. METHODS ONE HUNDRED EYES OF 98 CONSECUTIVE PATIENTS WITH PsRD were treated with vitrectomy alone without scleral Accepted for publication Jan 21, 2008. From the Department of Ophthalmology, Vitreo-Retinal Unit, Geneva University Hospitals, Geneva, Switzerland. Inquiries to Constantin J. Pournaras, Department of Ophthalmology, Geneva University Hospitals, 22 rue Alcide Jentzer, 1211 Geneva 14, Switzerland; e-mail: constantin.pournaras@hcuge.ch © 2008 BY ELSEVIER INC.ALL RIGHTS RESERVED. 0002-9394/08/$34.00 1063 doi:10.1016/j.ajo.2008.01.018