Surgical Complications of Primary Rhegmatogenous Retinal Detachment: A Meta-Analysis

Abstract

BackgroundTo investigate the surgical complications of scleral buckling (SB) and pars plana vitrectomy (PPV) performed on primary rhegmatogenous retinal detachment (RRD) and to discover which surgical procedures bring fewer complications.MethodsAn electronic literature search using the PubMed database, ISI Web of Knowledge and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and observational studies comparing SB with PPV on primary RRD. Outcome measures included intra-operative complications and early and late post-operative complications.ResultsDuring the operation, significantly less subretinal hemorrhage occurred in the PPV group than in the SB group (OR = 4.71; 95%CI, 1.33–16.64; p = 0.02) and the hypotony incidence was significantly higher in the SB group (OR = 18.24; 95%CI, 2.37–140.44; p = 0.005); however, the occurrence of iatrogenic breaks was significantly lower in the SB group (OR = 0.05; 95%CI, 0.01–0.21; p<0.0001). In the early stage of post-operation, significantly higher incidence of choroidal detachment was identified in the SB group than in the PPV group (OR = 10.19; 95%CI, 2.36–44.09; p = 0.002); patients undergoing SB had significantly higher odds of residual subretinal fluid (OR = 14.71; 95%CI, 1.84–117.32; p = 0.01); the occurrence of high intraocular pressure was significantly lower in the SB group (OR = 0.46; 95%CI, 0.23–0.89; p = 0.02); and no significant difference was shown in the incidence of epithelia defect (p = 0.37) between the two groups. In the late stage of post-operation, the incidence of diplopia/extraocular muscle dysfunction was significantly higher in the SB group (OR = 4.04; 95%CI, 1.30–12.52; p = 0.02); and significantly less cataract was observed in the SB group (OR = 0.20; 95%CI, 0.14–0.30; p<0.00001); no significant difference was found in the incidences of cystoid macular edema (p = 0.65), macular pucker (p = 0.52), post-operative proliferative vitreoretinopathy (p = 0.73) and epiretinal membrane (p = 0.47) in other late post-operative complications.ConclusionsThis meta-analysis suggests that PPV could be considered as potential surgical management on primary RRD.

Epidemiologic characteristics of retinal detachment surgery at a specialized unit in Denmark

“…This and the recent published meta‐analysis by Zhiping Lv et al. () support that PPV can be considered as potential surgical procedure for primary RRD.…”

“…This change in approach is debatable, but a recent meta‐analysis by Lv et al. () supports the use of PPV as potential first choice of surgical procedure for primary RRD.…”

“…By 2012, all RD's were treated with PPV, independent of lens status and age. This change in approach is debatable, but a recent meta-analysis by Lv et al (2015) supports the use of PPV as potential first choice of surgical procedure for primary RRD.…”

Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

“…Between 2005 and 2011, it also has been reported that there was an increasing trend for using PPV and PPV + SB as the primary retinal reattachment surgery [ 3 ]. Recent meta-analysis studies that examined the management of primary RRD have demonstrated that PPV achieved more favorable effects with less intra- or postoperative complications than SB [ 6 , 18 , 33 ].…”

Buckelchirurgie: Old Fashion oder Cutting Edge?

“…Als Resultat dieser Studie wurde für Augen mit mittelschwerer Netzhautablösung die Empfehlung ausgesprochen, phake Patienten primär mit Buckelchirurgie zu versorgen und aphake sowie pseudophake Augen primär zu vitrektomieren [17]. Diese in der SPR-Studie vorgenomme- [19]. Diese Komplikationen werden von den Autoren als schwerwiegender beurteilt als die erhöhte Rate an Katarakt, iatrogenen Netzhautlöchern und an postoperativen Augendruckspitzen in der pV-Gruppe.…”