DOI: 10.32364/2311-7729-2020-20-2-72-78
Rhegmatogenous retinal detachment: current treatment approaches
A.V. Doga, D.O. Shkvorchenko, L.A. Kryl’, M.R. Taevere, D.A. Buryakov
S.N. Fedorov NMRC “MNTK “Eye Microsurgery”, Moscow, Russian Federation
Rhegmatogenous retinal detachment (RRD) is a severe eye disease that may result in low vision or blindness in the lack of surgery. Three major surgical techniques for RRD are currently available, i.e., scleral buckling, pars plana vitrectomy, and pneumatic retinopexy. These techniques are successfully used for RRD as their primary efficacy is up to 90%. However, pneumatic retinopexy and scleral buckling do not completely eliminate vitreomacular tractions. In addition, these techniques can induce refractive errors, i.e., astigmatism and myopia. Meanwhile, vitrectomy may result in postoperative complications (i.e., cataract, secondary ocular hypertension, emulsification of silicone oil, keratopathy, and suprachoroidal hemorrhage). Therefore, there is disagreement regarding preferences for surgery. This paper discusses routine and promising surgical techniques for RRD, compare these techniques, and reviews novel technologies and randomized clinical studies that will sign ificantly improve surgical outcomes.
Keywords: rhegmatogenous retinal detachment, scleral buckling, vitrectomy, pneumatic retinopexy, YAG-laser retinotomy.
For citation: Doga A.V., Shkvorchenko D.O., Kryl’ L.A. et al. Rhegmatogenous retinal detachment: current treatment approaches. Russian Journal of Clinical Ophthalmology. 2020;20(2):72–78. DOI: 10.32364/2311-7729-2020-20-2-72-78.
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10. Lyskin P.V. Pathogenetic differences in regmatogenous retinal detachments. Modern Technologies in Vitreoretinal Pathology Treatment 2008. Theses of the scientific-practical conference. М., 2008:110–112 (in Russ.).
11. Lyskin P.V. New data on the mechanism of vitreoretinal adhesion and posterior vitreous detachment. Rossiyskaya detskaya oftal’mologiya. 2019;2:57–62 (in Russ.). DOI: 10.25276/2307-6658-2019-2-57-62.
12. Kislitsyna N.M., Novikov S.V., Shatskikh A.V., Kolesnik S.V. Vitreous body structures investigation using the Vitreocontrast suspension. Fyodorov Journal of Ophthalmic Surgery. 2013;4:66–70 (in Russ.).
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15. Byer N.E. Prognosis of asymptomatic retinal breaks. Arch. Ophthalmol. 1974;92:208–210. DOI: 10.1001/archopht.1974.01010010216005.
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18. Norton E.W.D. Intraocular gas in the management of selected retinal detachments. Trans. Am. Acad. Ophthalmol. Otolaryngol. 1973:77–85.
19. Gupta D., Ching J., Tornambe P.E. Clinically undetected retinal breaks causing retinal detachment: a review of options for management. Surv. Ophthalmol. 2018;63:579–588. DOI: 10.1016/j.survophthal.2017.08.002.
20. Jung J.J., Cheng J., Pan J.Y. et al. Anatomic, visual, and financial outcomes for traditional and nontraditional primary pneumatic retinopexy for retinal detachment. Am. J. Ophthalmol. 2018;200:187–200. DOI: 10.1016/j.ajo.2019.01.00.
21. Hwang J.F., Chen C.N., Lin J. Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique. Retina. 2011;2(31):257–261. DOI: 10.1097/IAE.0b013e3181e586f9.
22. Goldman D.R., Shah C.P., Heier J.S. Expanded criteria for pneumatic retinopexy and potential cost savings. Ophthalmology. 2014;121:318–326. DOI: 10.1016/j.ophtha.2013.06.037.
23. Kreissig I. Primary retinal detachment: A review of the development of techniques for repair in the past 80 years. Taiwan J. of ophthalmology. 2016;6(4):161–169. DOI: 10.1016/j.tjo.2016.04.006.
24. Kita M., Fujii Y., Kawagoe N., Hama S. Scleral buckling with a noncontact wide-angle viewing system in the management of retinal detachment with undetected retinal break: a case report. Clinical Ophthalmology. 2013;7:587–589. DOI: 10.2147/OPTH.S42923.
25. Seider M. I., Nomides R. E., Hahn P. et al. Scleral buckling with chandelier illumination. J. Ophthalmic Vis. Res. 2016;11(3):304–309. DOI: 10.4103/2008-322X.188402.
26. Sakono T., Otsuka H., Shiihara H., Yoshihara N., Sakamoto T. Acute bacterial endophthalmitis after scleral buckling surgery with chandelier endoillumination. Am. J. Ophthalmol. Case Rep. 2017;8:7–10. DOI: 10.1016/j.ajoc.2017.07.007.
27. Znaor L., Medic A., Binder S. et al. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst. Rev. 2019:1–10. DOI: 10.1002/14651858.CD009562.pub2.
28. Ashish Bedarkar, Ratnesh Ranjan, Perwez Khan et al. Scleral buckling-induced ocular parameter changes in different age group patients of rhegmatogenous retinal detachment. Taiwan J. Ophthalmol. 2017;7(2):94–99. DOI: 10.4103/tjo.tjo_7_17.
29. Lai M.M., Ruby A.J., Sarrafizadeh R. Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2008;28:729–734. DOI: 10.1097/IAE.0b013e318162b01c.
30. Zakharov V.D., Kostina N.E. Distinctive features of the microsurgical technique of the silicone oil tamponade in aphakic eyes. Fyodorov Journal of Ophthalmic Surgery. 2013;1:13–17 (in Russ.).
31. Shkvorchenko D.O., Zakharov V.D., Kakunina S.A. et al. Analysis of visual functions recovery in patients with regmatogenous retinal detachment after surgical treatment by the method of the single-port vitrectomy 25 G. Kataraktal’naya i refraktsionnaya khirurgiya. 2014;4:51–52 (in Russ.).
32. Shu I., Ishikawa H., Nishikawa H. et al. Scleral buckling versus vitrectomy for young japanese patients with rhegmatogenous retinal detachment in the era of microincision surgery: realworld evidence from a multicentre study in Japan. Acta. Ophthalmol. 2019;97(5):736–741. DOI: 10.1111/aos.14050.
33. Zakharov V.D., Shkvorchenko D.O., Kakunina S.A. et al. Surgical treatment of rheumatogenic retinal detachment with peeling of the internal limiting membrane. Prakticheskaya meditsina. 2017;9(2):91–96 (in Russ.).
34. Tahchidi H.P., Kazaykin V.N. The problem of completing silicone tamponade with giant retinal tears. Fyodorov Journal of Ophthalmic Surgery. 2001;3:49–55 (in Russ.).
35. Lyskin P.V., Zakharov V.D., Shpak A.A. et al. Evaluation of safety of double tamponade of vitreous cavity in surgical treatment of retinal detachment. Fyodorov Journal of Ophthalmic Surgery. 2013;1:22–26 (in Russ.).
36. Schramm C., Spitzer M.S., Henke-Fahle S. et al. The cross-linked biopolymer hyaluronic acid as an artificial vitreous substitute. Invest. Ophthalmol. Vis. Sci. 2012;53:613–621. DOI: 10.1167/iovs.11-7322.
37. Alekseev I.B., Korigiridsky A.R., Iomdina E.N. et al. Preclinical studies of the new Vitreolon vitreous substitute. Rossiyskaya detskaya oftal’mologiya. 2018;2:36–41 (in Russ.).
38. Hillier R.J., Felfeli Т., Berger A.R. et al. The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT). Ophthalmology. 2019;126(4):531–539. DOI: 10.1016/j.ophtha.2018.11.014.
39. Heimann H., Hellmich M., Bornfeld N. et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study): design issues and implications. SPR Study report no. 1.Graefe’s Archive for Clinical and Experimental Ophthalmology. 2001;239(8):567–574. DOI: 10.1007/s004170100319.
40. Hatef E. , Sena D.F., Fallano K.A. et al. Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2015:1–9. DOI: 10.1002/14651858.CD008350.pub2.
41. Zhou C., Lin Q., Wang Y., Qiu Q. Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: a multicenter, retrospective, observational consecutive case series. J. Int. Med. Res. 2018;46: 316–325. DOI: 10.1177/0300060517724931.
42. Shkvorchenko D.O., Kakunina S.A., Belousova E.V., Rusanovskaya A.V. Treatment of the fresh regmatogenic retinal detachment using the technique of microinvasive single-port vitrectomy. Prakticheskaya meditsina. 2012;2:151–152 (in Russ.).
43. Doga A.V., Volodin P.L., Kryl L.A. et al. Laser Retinotomy with “Ultra Q Reflex” System for the Prevention of Rhegmatogenous Retinal Detachment due to the Peripheral Horseshoe Tears. Ophthalmology in Russia. 2018;15(1):24–31 (in Russ.). DOI: 10.18008/1816-5095-2018-1-24-31.
44. Doga A.V., Shkvorchenko D.O., Kryl L.A. et al. Wide-field retinal optical coherence tomography for imaging of peripheral vitreoretinal interface and stratification of risk for rhegmatogenous retinal detachment recurrence. Saratovskiy nauchno-meditsinskiy zhurnal. 2019;15(2):456–459 (in Russ.).
45. Doga A.V., Shkvorchenko D.O., Kryl L.A. et al. Evaluation of the treatment results in patients with rhegmatogenous retinal detachment treated by combined microinvasive laser-surgical technology. Sovremennyye tekhnologii v oftal’mologii. 2019;1(26):363–368 (in Russ.). DOI: 10.25276/2312-4911-2019-1-363-368.
46. Bayzulaeva M.R., Doga A.V., Shkvorchenko D.O. et al. Assessment of retinal structural changes by wide-angle optical coherence tomography. Sovremennyye tekhnologii v oftal’mologii. 2019;4(29):20–23 (in Russ.). DOI: 10.25276/2312-4911-2019-4-20-23.
47. Egorov V.V., Egorov A.V., Smolyakova G.P. Prediction of the level of visual rehabilitation in patients with complete retinal reattachment after vitreoretinal surgery for rhegmatogenous retinal detachment and proliferative vitreoretinopathy. RMJ. Clinical ophthalmology. 2017;1:39–41 (in Russ.).
2. Rumpf J., Gonin J. Inventor of the surgical treatment for retinal detachment. Survey of ophthalmology. 1976;21(3):276–284. DOI: 10,1016/0039-6257 (76) 90125-9.
3. Schepens C.L. Progress in detachment surgery. Trans. Am. Acad. Ophthalmol. Otolaryngol. 1951;55:607–615.
4. Machemer R., Buettner H., Norton E.W., Parel J.M. Vitrectomy: a pars plana approach. Trans. Am. Acad.Ophthalmol. Otolaryngol. 1971;75(4):813–820.
5. Hilton G.F., Grizzard W.S. Pneumatic retinopexy. A two-step outpatient operation without conjunctival incision. Ophthalmology. 1986;93(5):626–641. DOI: 10.1016/s0161-6420 (86) 33696-0.
6. Gorshkov I.M., Zacharov V.D., Chodjaev N.S. et al. Bimanual endovitreal 27–29G surgery of rhegmatogenous retinal detachment. Fyodorov Journal of Ophthalmic Surgery. 2012;2:6–10 (in Russ.).
7. Shkvorchenko D.O., Zacharov V.D., Kakunina S.A. et al. Comparative estimation of surgical treatment results of rhegmatogenous retinal detachment. Fyodorov Journal of Ophthalmic Surgery. 2015;4:43–50 (in Russ.).
8. Mashchenko N.V., Khudiakov A.Y., Sorokin E.L. Comparative analysis of the long-term results of surgical treatment of primary rhegmatogenous retinal detachment using extra- and intraocular approaches. Fyodorov Journal of Ophthalmic Surgery. 2017;2:17–22 (in Russ.). DOI: 10.25276/0235-4160-2017-2-17-22.
9. Mitry D., Mb С., Fleck B. W. et al. Patogenesis of rhegmatogenous retinal detachment: Predisposing Anatomy and Cell Biology. Retina. 2010;30(10):1561–1572. DOI: 10.1097/IAE.0b013e3181f669e6.
10. Lyskin P.V. Pathogenetic differences in regmatogenous retinal detachments. Modern Technologies in Vitreoretinal Pathology Treatment 2008. Theses of the scientific-practical conference. М., 2008:110–112 (in Russ.).
11. Lyskin P.V. New data on the mechanism of vitreoretinal adhesion and posterior vitreous detachment. Rossiyskaya detskaya oftal’mologiya. 2019;2:57–62 (in Russ.). DOI: 10.25276/2307-6658-2019-2-57-62.
12. Kislitsyna N.M., Novikov S.V., Shatskikh A.V., Kolesnik S.V. Vitreous body structures investigation using the Vitreocontrast suspension. Fyodorov Journal of Ophthalmic Surgery. 2013;4:66–70 (in Russ.).
13. Kislitsyna N.M., Novikov S.V., Kolesnik S.V. et al. Anatomic and topographic features of vitreous and vitreoretinal interface in patients with rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. Prakticheskaya meditsina. 2016;1:150–157 (in Russ.).
14. Zakharov V.D., Kislitsyna N.M., Novikov S.V., Belikova S.V. Evaluation of the anatomical and topographic features of the vitreoretinal interface structure in patients with regmatogenous retinal detachment during chromovitrectomy by the “Vitreocontrast” suspension for intraoperative contrasting of the vitreous body structures. Sovremennyye tekhnologii lecheniya vitreoretinal’noy patologii. 2012:82 (in Russ.).
15. Byer N.E. Prognosis of asymptomatic retinal breaks. Arch. Ophthalmol. 1974;92:208–210. DOI: 10.1001/archopht.1974.01010010216005.
16. Sebag J. Vitreoschisis. Graefes. Arch. Clin. Exp. Ophthalmol. 2008;246:329–332. DOI: 10.1007/s00417-007-0743-x.
17. Bol’shunov A.V., Il’ina T.S., Rodin A.S., Likhnikevich E.M. The influence of risk factors on therapeutic efficacy of circumscribing laser coagulation at breakages of retinal periphery. Oftal’mokhirurgiya i terapiya. 2001;1:53–58 (in Russ.).
18. Norton E.W.D. Intraocular gas in the management of selected retinal detachments. Trans. Am. Acad. Ophthalmol. Otolaryngol. 1973:77–85.
19. Gupta D., Ching J., Tornambe P.E. Clinically undetected retinal breaks causing retinal detachment: a review of options for management. Surv. Ophthalmol. 2018;63:579–588. DOI: 10.1016/j.survophthal.2017.08.002.
20. Jung J.J., Cheng J., Pan J.Y. et al. Anatomic, visual, and financial outcomes for traditional and nontraditional primary pneumatic retinopexy for retinal detachment. Am. J. Ophthalmol. 2018;200:187–200. DOI: 10.1016/j.ajo.2019.01.00.
21. Hwang J.F., Chen C.N., Lin J. Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique. Retina. 2011;2(31):257–261. DOI: 10.1097/IAE.0b013e3181e586f9.
22. Goldman D.R., Shah C.P., Heier J.S. Expanded criteria for pneumatic retinopexy and potential cost savings. Ophthalmology. 2014;121:318–326. DOI: 10.1016/j.ophtha.2013.06.037.
23. Kreissig I. Primary retinal detachment: A review of the development of techniques for repair in the past 80 years. Taiwan J. of ophthalmology. 2016;6(4):161–169. DOI: 10.1016/j.tjo.2016.04.006.
24. Kita M., Fujii Y., Kawagoe N., Hama S. Scleral buckling with a noncontact wide-angle viewing system in the management of retinal detachment with undetected retinal break: a case report. Clinical Ophthalmology. 2013;7:587–589. DOI: 10.2147/OPTH.S42923.
25. Seider M. I., Nomides R. E., Hahn P. et al. Scleral buckling with chandelier illumination. J. Ophthalmic Vis. Res. 2016;11(3):304–309. DOI: 10.4103/2008-322X.188402.
26. Sakono T., Otsuka H., Shiihara H., Yoshihara N., Sakamoto T. Acute bacterial endophthalmitis after scleral buckling surgery with chandelier endoillumination. Am. J. Ophthalmol. Case Rep. 2017;8:7–10. DOI: 10.1016/j.ajoc.2017.07.007.
27. Znaor L., Medic A., Binder S. et al. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst. Rev. 2019:1–10. DOI: 10.1002/14651858.CD009562.pub2.
28. Ashish Bedarkar, Ratnesh Ranjan, Perwez Khan et al. Scleral buckling-induced ocular parameter changes in different age group patients of rhegmatogenous retinal detachment. Taiwan J. Ophthalmol. 2017;7(2):94–99. DOI: 10.4103/tjo.tjo_7_17.
29. Lai M.M., Ruby A.J., Sarrafizadeh R. Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2008;28:729–734. DOI: 10.1097/IAE.0b013e318162b01c.
30. Zakharov V.D., Kostina N.E. Distinctive features of the microsurgical technique of the silicone oil tamponade in aphakic eyes. Fyodorov Journal of Ophthalmic Surgery. 2013;1:13–17 (in Russ.).
31. Shkvorchenko D.O., Zakharov V.D., Kakunina S.A. et al. Analysis of visual functions recovery in patients with regmatogenous retinal detachment after surgical treatment by the method of the single-port vitrectomy 25 G. Kataraktal’naya i refraktsionnaya khirurgiya. 2014;4:51–52 (in Russ.).
32. Shu I., Ishikawa H., Nishikawa H. et al. Scleral buckling versus vitrectomy for young japanese patients with rhegmatogenous retinal detachment in the era of microincision surgery: realworld evidence from a multicentre study in Japan. Acta. Ophthalmol. 2019;97(5):736–741. DOI: 10.1111/aos.14050.
33. Zakharov V.D., Shkvorchenko D.O., Kakunina S.A. et al. Surgical treatment of rheumatogenic retinal detachment with peeling of the internal limiting membrane. Prakticheskaya meditsina. 2017;9(2):91–96 (in Russ.).
34. Tahchidi H.P., Kazaykin V.N. The problem of completing silicone tamponade with giant retinal tears. Fyodorov Journal of Ophthalmic Surgery. 2001;3:49–55 (in Russ.).
35. Lyskin P.V., Zakharov V.D., Shpak A.A. et al. Evaluation of safety of double tamponade of vitreous cavity in surgical treatment of retinal detachment. Fyodorov Journal of Ophthalmic Surgery. 2013;1:22–26 (in Russ.).
36. Schramm C., Spitzer M.S., Henke-Fahle S. et al. The cross-linked biopolymer hyaluronic acid as an artificial vitreous substitute. Invest. Ophthalmol. Vis. Sci. 2012;53:613–621. DOI: 10.1167/iovs.11-7322.
37. Alekseev I.B., Korigiridsky A.R., Iomdina E.N. et al. Preclinical studies of the new Vitreolon vitreous substitute. Rossiyskaya detskaya oftal’mologiya. 2018;2:36–41 (in Russ.).
38. Hillier R.J., Felfeli Т., Berger A.R. et al. The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT). Ophthalmology. 2019;126(4):531–539. DOI: 10.1016/j.ophtha.2018.11.014.
39. Heimann H., Hellmich M., Bornfeld N. et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study): design issues and implications. SPR Study report no. 1.Graefe’s Archive for Clinical and Experimental Ophthalmology. 2001;239(8):567–574. DOI: 10.1007/s004170100319.
40. Hatef E. , Sena D.F., Fallano K.A. et al. Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2015:1–9. DOI: 10.1002/14651858.CD008350.pub2.
41. Zhou C., Lin Q., Wang Y., Qiu Q. Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: a multicenter, retrospective, observational consecutive case series. J. Int. Med. Res. 2018;46: 316–325. DOI: 10.1177/0300060517724931.
42. Shkvorchenko D.O., Kakunina S.A., Belousova E.V., Rusanovskaya A.V. Treatment of the fresh regmatogenic retinal detachment using the technique of microinvasive single-port vitrectomy. Prakticheskaya meditsina. 2012;2:151–152 (in Russ.).
43. Doga A.V., Volodin P.L., Kryl L.A. et al. Laser Retinotomy with “Ultra Q Reflex” System for the Prevention of Rhegmatogenous Retinal Detachment due to the Peripheral Horseshoe Tears. Ophthalmology in Russia. 2018;15(1):24–31 (in Russ.). DOI: 10.18008/1816-5095-2018-1-24-31.
44. Doga A.V., Shkvorchenko D.O., Kryl L.A. et al. Wide-field retinal optical coherence tomography for imaging of peripheral vitreoretinal interface and stratification of risk for rhegmatogenous retinal detachment recurrence. Saratovskiy nauchno-meditsinskiy zhurnal. 2019;15(2):456–459 (in Russ.).
45. Doga A.V., Shkvorchenko D.O., Kryl L.A. et al. Evaluation of the treatment results in patients with rhegmatogenous retinal detachment treated by combined microinvasive laser-surgical technology. Sovremennyye tekhnologii v oftal’mologii. 2019;1(26):363–368 (in Russ.). DOI: 10.25276/2312-4911-2019-1-363-368.
46. Bayzulaeva M.R., Doga A.V., Shkvorchenko D.O. et al. Assessment of retinal structural changes by wide-angle optical coherence tomography. Sovremennyye tekhnologii v oftal’mologii. 2019;4(29):20–23 (in Russ.). DOI: 10.25276/2312-4911-2019-4-20-23.
47. Egorov V.V., Egorov A.V., Smolyakova G.P. Prediction of the level of visual rehabilitation in patients with complete retinal reattachment after vitreoretinal surgery for rhegmatogenous retinal detachment and proliferative vitreoretinopathy. RMJ. Clinical ophthalmology. 2017;1:39–41 (in Russ.).
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