![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
ABSTRACT
Introduction
Primary rhegmatogenous retinal detachment (RRD) repair with modern surgical techniques provides high rates of anatomic success; however, anatomic failure may still occur with any primary surgery, including after pneumatic retinopexy (PR), scleral buckle (SB), and pars plana vitrectomy (PPV), resulting in recurrent RRD.
Areas covered
This review includes a summary of surgical options and management strategies for eyes with primary failure of PR, SB, and PPV.
Expert opinion
No standardized protocol is available for determining the optimal secondary surgical options to treat recurrent RRD. However, understanding of the causes and characteristics of the re-detachment, expected anatomic success rates with each surgical option, and potential complications, may improve the outcomes after re-operations. Causes of primary failure include formation of new breaks, re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy (PVR). Rescue PR, revision of SB, and reoperation with PPV with membrane peeling, relaxing retinectomy, and/or long-acting tamponade combined with or without encircling SB, are effective options depending on the cause of primary failure and characteristics and severity of the re-detachment. Further advances in the management of PVR, which is a major cause of primary failure, will help improve treatment outcomes for eyes with complicated recurrent detachments.
Article highlights
Recurrent rhegmatogenous retinal detachment may occur in 10–30% of the cases after primary pneumatic retinopexy, scleral buckle, and pars plana vitrectomy depending on the characteristics of the primary retinal detachment and type of primary surgery performed.
Treatment options for eyes with failure of primary surgery have no standardized protocol. Typically, surgical choices are based on the causes and characteristics of the retinal re-detachment.
Causes of primary failure include new retinal breaks, unsealed or re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy.
Re-detachment rates and the need for second surgeries are higher for pneumatic retinopexy than for scleral buckle or pars plana vitrectomy.
Rescue pneumatic retinopexy is an effective treatment for uncomplicated recurrent retinal detachments associated with a retinal break in the superior retinal quadrants.
Scleral buckle with encircling band is effective for relieving the tractional forces responsible for recurrent retinal detachment.
Pars plana vitrectomy is the most common and effective approach for complicated detachments that require removal of traction associated with proliferative vitreoretinopathy.
Evolution of pars plana vitrectomy has facilitated treatment of proliferative vitreoretinopathy, although technical challenges remain, particularly in eyes with grade C proliferative vitreoretinopathy that re-detach under silicone oil.
Final anatomic success for recurrent retinal detachment is greater than 90% in most cohorts; however, eyes requiring more than two surgeries for retinal reattachment have poor functional outcomes and more complications.
Declaration of interest
Y. Yonekawa is a consultant for Alcon, Bausch + Lomb, Pykus, Regeneron, Tarsus, and Versant Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.