Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment

Abstract

ABSTRACT.Purpose: To conduct a randomized prospective clinical trial to compare primary vitrectomy without scleral buckling versus conventional scleral buckling surgery in pseudophakic primary retinal detachment (PPRD) in terms of anatomic attachment rate, functional outcome and complications. Methods: Fifty consecutive eyes of 50 patients with PPRD were randomized into two groups, with 25 patients in each of group 1 (scleral buckling group) and group 2 (pars plana vitrectomy without buckling group) in a hospital setting and followed up at 1 week, 2 weeks, 6 weeks and 6 months. Results: A primary reattachment rate of 76% (19 retinas) was obtained in group 1, while a reattachment rate of 84% (21 retinas) was achieved in group 2. The final anatomic reattachment rate was 100% in both groups. The causes of failure in group 1 were proliferative vitreoretinopathy in five eyes and open break/ missed break in one eye. The causes of failure in group 2 were missed break/ open break in three eyes and proliferative vitreoretinopathy in one eye. Best corrected visual acuity (BCVA) at 2 weeks was better in group 1, while the final BCVA at end of 6 months was two lines better in group 2. The mean change in refractive error was -1.38 D in group 1 and -0.85 D in group 2. Conclusions: Pars plana vitrectomy without buckling provides an effective treatment for PPRD and results in better longterm visual and anatomic outcomes than conventional scleral buckling.

Scleral buckling surgery for rhegmatogenous retinal detachment with subretinal proliferation

“…Most studies have reported comparable anatomical and visual outcomes in patients with uncomplicated RRD treated by vitrectomy or scleral buckling. [1][2][3][4][5] In patients with complex RRD, however, pars plan vitrectomy with or without scleral buckling surgery has been associated with significantly higher success rate compared with scleral buckling alone. 6 Proliferative vitreoretinopathy (PVR) is a wound healing process characterized by migration and proliferation of resident ocular cells including retinal pigment epithelial cells and invading immune cells leading to formation of adherent membranes over and under the retina.…”

Refractive change after vitrectomy for epiretinal membrane in pseudophakic eyes

“…The refractive changes following vitrectomy for pseudophakic retinal detachment have been reported between )0.15 (Campo et al 1999) and )0.84 D (Sharma et al 2005). Studies including various vitreoretinal pathologies found refractive changes between )0.30 (Kumagai et al 2001) and )0.45 D (Byrne et al 2008) in pseudophakic vitrectomy.…”

Repair of Primary Noncomplex Rhegmatagenous Retinal Detachment

“…In general, investigators found a significant improvement in VA following successful SB repair in patients with pre-operative macular detachment and stable to improved acuities in patients without macular involvement with only a very small number of patients losing ≥2 lines of vision. 44 76,77 Interestingly, the large multicenter trial conducted by the SPR study group did find a significantly improved mean change in BCVA after SB as opposed to PPV-SB in the phakic subgroups, which was independent of cataract development. 74 Much of the discussion regarding the use of SB or PPV/PPV-SB for repair of primary noncomplex RRD relates to the quite different sets of associated complications.…”

“…In light of the evidence supporting PPV as an equivalent, 20,39,40,44,[75][76][77][78][79] if not superior, [72][73][74] option to SB for noncomplex RRD, it is unsurprising that, in recent years, the focus of debate has increasingly shifted from primary SB versus primary PPV to questions relating to the appropriate adjuvant procedures (e.g. SB, 360° endolaser) to utilize in conjunction with PPV.1 2,89 To this end, several investigators have undertaken comparative evaluations of PPV and PPV-SB, the results of which are detailed in Table 6.…”