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MUMIN HOCAOGLU, MURAT KARACORLU, ISIL SAYMAN MUSLUBAS, HAKAN OZDEMIR, SERRA ARF, AND
OMER UYSAL
I
PURPOSE: To compare the outcomes for patients with NTRARETINAL PROLIFERATION OF ALL NON-NEURONAL
rhegmatogenous retinal detachment (RRD) and patients cell types in the retina after retinal detachment
with retinal detachment (RD) following penetrating (RD) has been shown in experimental trials.1 Retinal
injury after combined 360 degree retinotomy, anterior pigment epithelium (RPE) and Müller cells are the prin-
flap retinectomy, and radial retinotomy for the manage- cipal cell types responsible for the formation of
ment of advanced proliferative vitreoretinopathy (PVR). abnormal cellular accumulations in the vitreous cavity
DESIGN: Retrospective, comparative, interventional and subretinal space.2 Clinically, this condition is
case series. known as proliferative vitreoretinopathy (PVR). The
METHODS: Twenty-four eyes (60%) of 24 patients PVR process is characterized by formation of periretinal
diagnosed with RRD and 16 eyes (40%) of 16 patients fibrocellular membranes, intraretinal fibrosis, and subre-
diagnosed with RD after penetrating injury whose sur- tinal bands.3
gery involved 360 degree retinotomy, anterior flap reti- Treatment of RD in eyes with PVR is challenging and re-
nectomy, and radial retinotomy for the management of quires complex vitreoretinal surgery. This may involve
advanced PVR (grade D) were included in the analysis. scleral buckling, pars plana vitrectomy (PPV) with mem-
The primary outcome was anatomic surgical success. Sec- brane peeling, retinotomy, retinectomy, and intraocular
ondary outcomes were change in visual acuity (VA) and tamponade injection. Despite extensive peeling and
postoperative complications. removal of membranes, in some cases intraoperative retinal
RESULTS: The mean number of previous interventions reattachment cannot be achieved.4 In these cases, there
in the RRD and trauma groups were 1.04 and 1.31, seems to be some intraretinal fibrosis causing shortening
respectively (P [ .13). After 51.5 (± 52.7) months of of the chronically detached retina. In severe cases, relaxing
mean follow-up, the complete retinal reattachment rates retinotomy is often needed.5
for the RRD and trauma groups were 79% (19/24) and Since being described by Machemer in 1979, retinotomy
75% (12/16), respectively (P > .99). The final mean has been used for the management of cases with
VA was 2.2 logMAR (20/2000) in both groups, with severe PVR.6 In 1985, 360 degree retinotomy was introduced
improvement in the RRD group (P [ .04). The most by Haut and associates.7,8 Such circumferential relaxing
common postoperative complications in the RRD and retinotomy is helpful in the management of
trauma groups, respectively, were persistent hypotony anteroposterior retinal shortening in eyes with intraretinal
in 6 eyes (25%) and 5 eyes (31%) (P [ .73), corneal fibrosis secondary to chronic RD. However, it has been
damage in 8 eyes (29%) and 6 eyes (38%) (P [ .34), proposed that it is not effective in the management of
and epiretinal membrane in 5 eyes (20.8%) and 4 eyes circumferential shortening commonly found in more
(25%) (P > .99). advanced stages of PVR.
CONCLUSIONS: Only 25% of the eyes (10/40) had VA High anatomic success rates in patients with advanced
of 20/200 or better. The aim of peripheral 360 degree PVR were achieved by Lim and associates, who reported
retinotomy, anterior flap retinectomy, and radial retinot- performing combined circumferential retinectomy and
omy is to obtain retinal reattachment, which is otherwise large radial retinotomy in 2009.9 A PubMed search
unachievable. (Am J Ophthalmol 2016;163:115–121. revealed no further information on the anatomic and func-
Ó 2016 by Elsevier Inc. All rights reserved.) tional outcomes since the introduction of this surgical
technique.
In this retrospective study, we compared the anatomic
Accepted for publication Dec 3, 2015.
From the Istanbul Retina Institute (M.H., M.K., I.S.M., S.A.); and the and functional outcomes of patients diagnosed with rheg-
Departments of Ophthalmology (H.O.) and Biostatistics (O.U.), matogenous retinal detachment (RRD) and patients with
Bezmialem Vakif University, School of Medicine, Istanbul, Turkey. RD after penetrating injury whose surgery involved 360 de-
Inquiries to Murat Karacorlu, Istanbul Retina Institute, Hakkı Yeten
Cad. Unimed Center No: 19/7, Fulya – Şişli, Istanbul 34349, Turkey; gree retinotomy, anterior flap retinectomy, and radial reti-
e-mail: murat.karacorlu@istanbulretina.com notomy for the management of complex RD.
FUNDING/SUPPORT: NO FUNDING OR GRANT SUPPORT. FINANCIAL DISCLOSURES: THE FOLLOWING AUTHORS HAVE NO
financial disclosures: Mumin Hocaoglu, Murat Karacorlu, Isil Sayman Muslubas, Hakan Ozdemir, Serra Arf, and Omer Uysal. All authors attest that
they meet the current ICMJE criteria for authorship.