Evolution of vitrectomy techniques in the treatment of retinal detachment: impact on the recurrence rate and postoperative complications

Abstract

This article systematically reviews the evolution of vitrectomy techniques for treating retinal detachment, focusing on innovations that impact recurrence rates and postoperative complications. Vitrectomy is a surgical technique used to treat various retinal conditions, such as rhegmatogenous retinal detachment and macular holes, by removing the vitreous humor to directly access and treat the retina. Since the first pars plana vitrectomy (PPV) in 1972, the development of instruments and techniques, such as microincision and advances in visualization systems, has improved surgical outcomes and patient recovery. However, complications such as cataracts, vitreous hemorrhage, and proliferative vitreoretinopathy remain significant challenges. The study employed a systematic review of articles published over the past 20 years in databases like PubMed and LILACS, selecting 5 highly relevant studies from an initial 120 identified. Inclusion criteria covered human studies on vitrectomy techniques and their technological innovations. The analysis addressed techniques such as vitrectomy with internal limiting membrane peeling, inverted flap for macular holes, and microincision vitrectomy with wide-angle visualization. The results showed that pars plana vitrectomy (PPV) is effective in achieving anatomical success in cases of retinal detachment, especially with multiple interventions. Adding scleral buckle to PPV did not show significant long-term benefits. For detachment associated with macular holes, the inverted flap technique had a higher anatomical success rate than conventional peeling. Microincision vitrectomy proved effective for primary detachment treatment, with high rates of retinal reattachment. In patients with diabetic tractional retinal detachment, anatomical success did not guarantee significant functional improvements, emphasizing the importance of early interventions. The conclusion suggests that technique selection should be individualized, considering clinical characteristics such as the presence of proliferative vitreoretinopathy and macular status. Less invasive techniques demonstrate benefits for primary detachments, while scleral buckling may reduce cataract progression in rhegmatogenous detachment cases. Future studies are needed to optimize surgical choice criteria and improve long-term outcomes, especially in complex cases.