Retinal Detachment With Inferior Retinal Breaks

Abstract

Introduction: Rhegmatogenous retinal detachments with inferior retinal breaks are believed to have a higher risk of recurrent rhegmatogenous retinal detachment. This study compared anatomic and visual outcomes between primary pars plana vitrectomy (PPV) and combination PPV with scleral buckle (PPV/SB) for rhegmatogenous retinal detachments with inferior retinal breaks. Methods: This is an analysis of the Primary Retinal Detachment Outcomes study, a multi-institutional cohort study of consecutive primary rhegmatogenous retinal detachment surgeries from January 1, 2015, through December 31, 2015. The primary outcome was single-surgery success rate. Only eyes with inferior retinal breaks (one break in the detached retina between five and seven o'clock) were included. Results: There were 238 eyes that met the inclusion criteria, 95 (40%) of which underwent primary PPV and 163 (60%) that underwent combined PPV/SB. The single-surgery success rate was 76.8% for PPV and 87.4% for PPV/SB (P = 0.0355). This remained significant on multivariate analysis (P = 0.01). Subgroup analysis showed that a superior single-surgery success rate of PPV/SB was especially noted in phakic eyes (85.2% vs. 68.6%; P = 0.0464). Conclusion: Retinal detachment with inferior retinal breaks had a higher single-surgery success rate if treated with PPV/SB compared with PPV alone, particularly in phakic eyes.

Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks

“…Retinal detachments with inferior breaks jeopardize single surgery success rates due to the potential for incomplete tamponade and higher risk of PVR. [1][2][3][6][7][8] The recent PRO study (report number 9) comparing anatomical success in eyes of patients with primary RD and a single inferior break found a significant advantage for PPV/SB (with an encircling band) (87.4%) vs PPV alone (76.8%) at 1-year follow-up. 6 Other recent studies, with different tamponade agents and lower than average success rates, have reported comparable outcomes with PPV vs PPV/SB alone.…”

“…[1][2][3][6][7][8] The recent PRO study (report number 9) comparing anatomical success in eyes of patients with primary RD and a single inferior break found a significant advantage for PPV/SB (with an encircling band) (87.4%) vs PPV alone (76.8%) at 1-year follow-up. 6 Other recent studies, with different tamponade agents and lower than average success rates, have reported comparable outcomes with PPV vs PPV/SB alone. [6][7][8]14,15 Perhaps, the main caveat inherent to any retinal detachment study is the presence of variables which cannot always be well-accounted for which significantly Figure 1 The location of the inferior-most break is marked externally using a scleral depressor marker under direct visualization (A).…”

“…1,[3][4][5] Nevertheless, it has been demonstrated that in cases of multiple anterior or inferior breaks or RD with proliferative vitreoretinopathy (PVR), combining an encircling scleral buckle with PPV may improve anatomical outcomes. [1][2][3][4][5][6] The Single surgery success rate of combined PPV/SB has been reported to be significantly higher in eyes with inferior breaks compared to PPV alone in phakic or pseudophakic eyes in recent large cohort studies. 1,6,7 Nevertheless, several studies have demonstrated comparable outcomes in these cases with PPV alone, especially in pseudophakic eyes, while avoiding the potential complications associated with the presence of an encircling band.…”

“…[1][2][3][4][5][6] The Single surgery success rate of combined PPV/SB has been reported to be significantly higher in eyes with inferior breaks compared to PPV alone in phakic or pseudophakic eyes in recent large cohort studies. 1,6,7 Nevertheless, several studies have demonstrated comparable outcomes in these cases with PPV alone, especially in pseudophakic eyes, while avoiding the potential complications associated with the presence of an encircling band. 6,8 Many variations of scleral buckling with or without PPV have been described in the literature.…”

“…1,6,7 Nevertheless, several studies have demonstrated comparable outcomes in these cases with PPV alone, especially in pseudophakic eyes, while avoiding the potential complications associated with the presence of an encircling band. 6,8 Many variations of scleral buckling with or without PPV have been described in the literature. 9,10 Most attempt at minimizing complications, without affecting the added benefits of buckling support.…”