The incidence of combined retinal detachment with associated choroidal detachment is reported about 2-8.6%[10-12]. Li et al.revealed that proportion of RRD/CD can be as high as 18.7% among RRD patients when diagnosed by UBM. Although UBM can help detecting mild choroidal detachment which may be missed out on B ultrasound examination, ciliary body detachment alone may account for a large proportion of this higher incidence. Our previous study showed 1/4 of RRD had cilary body detachment detected by UBM without concurrent choroidal detachment on B ultrasound examination, but ciliary body detachment alone did not differ from those patients without cilary body detachment in both anatomic reattachment rate and postoperative visual acuity improvement(in Chinese). So in our current retrospective study, ciliary body detachment alone was not included. The relationship between the severity of ciliary body detachment and choroidal detachment is somewhat puzzling. Although in those eyes classified as severe choroidal detachment, the majority had also severe ciliary body detachment, eyes with severe choroidal detachment can present with mild ciliary body detachment while eyes with severe ciliary body detachment may had only mild choroidal detachment.
Our case series observation demonstrated that 82.4% of retinal reattachment rate after single operation can be achieved in the absence of preoperative steroids intervention. Though one case was refilled with SO after membrane peeling, he is still regarded as successful case after single operation. The reason for refilling SO is just for the safety as the retinal was still uneven after membrane peeling. Postoperative follow-up showed the retina was well attached without any visible retinal tear or hole. Even this case was not inclued in the single operation success list, this result is still comparable to those reports with preoperative steroids, that is from 51% to 81.8%[2,3,5,8,13-15 ]. Because of the severe inflammation throughout the course of the disease in patients with RRD/CD, many researchers believed that preoperative administration of steroids could benefit the surgical outcome. Literature search showed that most of these studies mainly evaluated the effects of preoperative administration of steroids between different routes: systemic or periocular or intravitreal administration. But only two of these studies compared the effects of preoperative steroids to steroids-sparing treatment, and they showed contradict results [2,5] Study conducted by Denwattana et al  disclosed that preoperative steroid treatment can significantly improved CD before vitrectomy, but seemed not to improve the single-operation retinal reattachment rate or visual acuity at 3 months when compared to no steroid treatment in RRD/CD patients. It seems that although preoperative steroids can help controlling inflammation, it may be not as so important as we once thought. We think the quickest way to control the inflammation shall be established in the prompt reattachment of the detached retina, thus completely breaking the vicious cycle in RRD/CD.
studies showed eyes left phakic at the completion of surgery may have a lower rate of anatomical success when compared with eyes rendered aphakic or pseudophakic, and the proportion of postoperative hypotony was also lower in those eyes that were aphakic after surgery when compared with those eyes that were nonaphakic[6,7]. Our previous report also demonstrated that lensectomy+vitrectomy+silicone oil tamponade offered better result in patients with RRD/CD , as this allowed more thorough cleavage of peripheral vitreous,leaving more space for the fill of SO. Recently , Xu H, et alfound that 23G PPV+phaco+capsulotomy without IOL implantation had a significantly higher reattachment rate (78%) than 23G PPV+phaco +IOL implantation (40%) in treating RRD/CD. We think primary IOL implantation may aggregate the already severe inflammation in this disease entities, thus reducing the surgical outcomes. Our current series observation showed combined phacovitrectomy without IOL implantation had similar results as those reported by Xu and Gui[3,16 ]. Phacovitrectomy seems more efficient than combined vitrectomy and lensectomy and reserved the advantage of micro-invasive vitrectomy. When doing the phaco, it seems more easily to keep an intact posterior capsular bag, thus, reducing the necessity of performing an ando hole. Phacovitrectomy can remove opacified lens to make a better viewing of the fundus when there is an already existed cataract. Even though the lens are temporary clear, cataract will eventually progress after vitrectomy with gas or SO tamponade and cataract surgery after vitrectomy becomes complex . When eye is aphakic, it also gives a more wider viewing of fundus after gas-fluid exchange under wide angle viewing system, making peripheral photocoagulation more convenient.