In our study, inexperienced surgeons were able to match the success rate of an experienced surgeon in uncomplicated RRD from the very start, suggesting a short learning curve. Although there was a statistically significant age difference between the two study groups, we do not believe it influenced the results since the anatomical and functional characteristics of retinal detachment were similar in both groups. Single operation success rates in both groups were comparable to previously published figures for 25 g PPV with gas tamponade[10–13]. We believe this is due to the simplified operation technique used in our clinic. We try to limit the use of surgical techniques that have not been shown to improve uncomplicated RRD surgery outcomes. These include the use of perfluorodecalin[14, 15], complete subretinal fluid drainage[10, 16, 17], and 360° retinopexy. Limiting the use of these techniques may also prevent certain postoperative complications[19–22].
Surgical techniques employed by the experienced and surgeons in our study were similar, exceptions being the selection of intraocular tamponade and frequency of sclerotomy suturing. The inexperienced surgeons used C3F8 gas more often, which is longer lasting and the more “secure” option. We believe this was due to inexperience a subsequent lack of self-confidence which led inexperienced surgeons to use C3F8 gas even in the cases where it might not have been necessary. In our opinion, the more frequent use of C3F8 in ISG was also the reason for higher cataract surgery rate after the PPV between the ESG and ISG, although the difference was not statistically significant. The higher rate of sclerotomy suturing could possibly be explained by the longer operating times in the ISG; however, we do not have data to support this claim as the duration of the operation was not recorded.
The complication rate was very similar in both study groups. There was a notable difference in cataract surgery rate after the PPV between the ESG and ISG, although the difference was not statistically significant The low postoperative intraocular hypotony rate can be explained by the oblique cannula insertion technique used by all surgeons[23, 24] and the use of digital palpation to assess IOP after the removal of cannulas.
Other studies have shown comparable results in PPV for RRD between experienced and inexperienced surgeons[25–30]. Ehrlich et al. and Dugas et al.[25, 26] compared the success rates of sutureless PPV for RRD between experienced and inexperienced surgeons and used similar exclusion and inclusion criteria as our study. In both these studies, the combined single operation success rate for both studies was 75% (80.9% and 75.4%, respectively, for experienced surgeons and 70.0% and 74.8%, respectively, for inexperienced surgeons), which was significantly lower than in our study. This can be explained by the improvements in surgical instruments and vitrectomy machines as well as in surgical techniques. For example, the high-speed vitrectomy has been shown to lower the number of iatrogenic retinal tears during PPV . It should also be noted that in a study by Ehrlich et al., the less experienced vitrectomy surgeons were recruited from fellows who had extensive experience in other intraocular procedures whereas in our study, both inexperienced surgeons had no previous experience with intraocular surgery.