Peripheral 360 Degree Retinotomy, Anterior Flap Retinectomy, and Radial Retinotomy in the Management of Complex Retinal Detachment.

PURPOSE: To compare the outcomes for patients with rhegmatogenous retinal detachment (RRD) and patients with retinal detachment (RD) following penetrating injury after combined 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced proliferative vitreoretinopathy (PVR).

DESIGN: Retrospective, comparative, interventional case series.

METHODS: Twenty-four eyes (60%) of 24 patients diagnosed with RRD and 16 eyes (40%) of 16 patients diagnosed with RD after penetrating injury whose surgery involved 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced PVR (grade D) were included in the analysis. The primary outcome was anatomic surgical success. Secondary outcomes were change in visual acuity (VA) and postoperative complications.

RESULTS: The mean number of previous interventions in the RRD and trauma groups were 1.04 and 1.31, respectively (P = .13). After 51.5 (± 52.7) months of mean follow-up, the complete retinal reattachment rates for the RRD and trauma groups were 79% (19/24) and 75% (12/16), respectively (P > .99). The final mean VA was 2.2 logMAR (20/2000) in both groups, with improvement in the RRD group (P = .04). The most common postoperative complications in the RRD and trauma groups, respectively, were persistent hypotony in 6 eyes (25%) and 5 eyes (31%) (P = .73), corneal damage in 8 eyes (29%) and 6 eyes (38%) (P = .34), and epiretinal membrane in 5 eyes (20.8%) and 4 eyes (25%) (P > .99).

CONCLUSIONS: Only 25% of the eyes (10/40) had VA of 20/200 or better. The aim of peripheral 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy is to obtain retinal reattachment, which is otherwise unachievable.