The factors that effect the success in Pars Plana Vitrectomy

Purpose: To evaluate preoperative, peroperative, and postoperative factors that effect the anatomic and functional success in pars plana vitrectomy (PPV).Material-method: Two hundreds fourteen eyes of 210 patients were included in this study. The cases were followed up average 13,6±6,3 months (at least 6 months and maximum 26 months) after surgery between the date of November 2006 - April 2009.Findings: The anatomic success was 85.3% after the first surgery and 95.1% after the end of repeated surgeries in rhegmatogenous retinal detachment (RRD) group. The functional success was 70,7% after the repeated surgery in RRD group. The cases who undergone PPV due to RRD without proliferative vitreoretinopathy (PVR), the anatomic success was 96.2% and the functional success was 83%. The cases who undergone PPV due to RRD within 10 days after the symptoms appeared; the anatomic success was 95%, functional success was 100%. The cases who had macular detachment, the anatomic success was 84,2% and the functional success was 65,7%. The cases who had not macular detachment, the anatomic success was 100%, and the functional success was 91.6%. The anatomic success was found 90.2% in phakic cases, 78,7% in pseudophakic cases, and 75% in aphakic cases in the cases who undergone PPV due to RRD. Anatomic and functional success was found 80% in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR). The cases who undergone PPV for tractional retinal detachment (TRD), epiretinal membrane (ERM) and vitreomacular traction syndrome (VMT) due to proliferative diabetic retinopathy (PDR), the anatomic success was found 61.5%, 71.4%, and 71.4% respectively in PDR group, the functional success was found 61.5%, 71.4%, and 71.4% respectively in PDR group. The cases which have another systemic disease additional to DM, the anatomic success was 70%, the functional success was 73.3%. The cases which did not have any another systemic disease except DM, the anatomic success was 92%, the functional success was 92,2%. Anatomic success was 84,3% in the cases who were injected intravitreal bevacizumab before the surgery and 64% in the cases who were not injected. The cases who undergone PPV for VH due to central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), choroidal neovascularization (CNV), posterior vitreous detachment (PVD), retinal macroaneurysm, Terson's syndrome and trauma; the anatomic success was 100%, 85.7%, 100%, 66.6%, 100%, 100%, 100%, respectively. Best spectacle-corrected visual acuity (BSCVA) increased in all cases except CNV. In the cases who undergone PPV within seven days for drop nucleus, BSCVA was found 0.5 and better in the 30% of cases, and 0.1 and better in the 80% of cases. In the cases who undergone PPV after seven days for drop nucleus, BSCVA was found 0.5 and beter in the 16,6% of cases, 0.1 and better in the 80% of cases. Redetachment rate after silicon oil removal was 10% in the cases were operated due to RRD and 6% in the cases were operated due to PDR.Conclusion: Presence of PVR, the duration between the symptoms and surgery, the presence and duration of macular detachment, lower BSCVA before the surgery, the pseudophakic and aphakic cases affect negatively on the surgical success in RRD groups. In PDR cases, severity of retinopathy, elder age, presence of a systemic disease additional to DM, and the duration of DM affect negatively on the surgical success. VEGF injection before the surgery and using silicone oil affect positively on the surgical success in PDR groups. Well management the complications after PPV improve level of surgical success.