Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments

Ong, Sally S.; Ahmed, Ishrat; Gonzales, Anthony; Al-Fakhri, Abdullmajeed S.; Alsubaie, Hamad; Al-Qhatani, Faisal S.; Alsulaiman, Sulaiman M.; Mura, Marco; Maia, Maurício; Kuroiwa, Dante Akira Kondo; Maia, Natalia Trench; Berrocal, María H.; Wu, Lihteh; Zas, Marcelo; Francos, Juan Pablo; Cubero-Parra, Juan Manuel; Arsiwala, Lubaina Tayeb; Handa, James T.; Arévalo, J. Fernando

doi:10.1016/j.oret.2022.03.004

Cited by 5 publications

(30 citation statements)

References 37 publications

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“…The final postoperative visual acuity was comparable to that in previous studies on surgery in cases with macula-off RRD [ 29 , 30 ]. We did not observe any significant difference in the final visual outcome between the two surgical groups, which is consistent with a recent study by Ong et al [ 28 ]. However, it is worth pointing out that the p-value of this comparison was trending towards significance with worse visual outcomes in the buckling group compared to the vitrectomy group.…”

Section: Discussionsupporting

confidence: 93%

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Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment

Quiroz-Gonzalez

Lima-Gómez

2023

Int J Retin Vitr

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Background Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that can be treated with various surgical approaches. The role of scleral buckling remains controversial because of its potential long-term deleterious effects on choroidal vascular perfusion and the limited knowledge of this entity. Methods A total of 135 eyes were retrospectively selected, including 115 with surgically resolved RRD and 20 healthy control eyes. Of the surgically treated eyes, 64 underwent vitrectomy alone, while 51 underwent scleral buckling combined with vitrectomy. Best-corrected visual acuity (BCVA) was evaluated along with the choroidal vascularity index (CVI) as a metric for the state of the choroidal vasculature. BCVA was compared before and after surgery, and the postoperative BCVA was analyzed with the CVI using correlation and multivariate regression analyses. Results The preoperative BCVA of the RRD eyes was significantly worse than that of the control eyes, and significantly improved after surgery. However, the long-term postsurgical BCVA was still inferior to that of the control eyes. No significant differences in visual function were found between the two surgical groups. The average CVI was 57.35% in the control eyes, 63.76% in the eyes that underwent vitrectomy, and 53.37% in buckled eyes. The differences in CVI were significant among the three groups. Among the surgical patients, negative Pearson’s correlations were found between CVI and postoperative BCVA (expressed in logMAR). A multivariate linear regression model containing four parameters revealed that CVI was the only variable with a significant influence on postoperative BCVA, while the length of time with a detached macula did not have an effect. Conclusions RRD surgery drastically restored vision, but the effect of RRD lingered, as postsurgical visual acuity remained inferior to that of the control eyes. The CVI varied between the treatment groups, likely due to both disease pathology and the impact of the surgery. The correlation between CVI and BCVA indicates the important role that the choroidal vasculature plays in visual function.

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Section: Discussionsupporting

confidence: 93%

“…The disadvantages of vitrectomy include specific positioning and travel restrictions after the surgery. Surgical outcomes can be improved by combining PPV with SB, a combination that has recently been demonstrated to be slightly more favorable in children with giant retinal tear-related detachments [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment

Quiroz-Gonzalez

Lima-Gómez

2023

Int J Retin Vitr

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“…This association was statistically significant in the univariate analysis only. A large retrospective study by Ong et al 14 concluded that encircling band use achieves significantly better anatomic and visual outcomes in pediatric GRT cases (<18 years) but does not improve results compared with PPV alone in adults. A recent systematic review addressing the use of encircling buckling in GRTs concluded that randomized controlled trials provided no evidence on this matter.…”

Section: Discussionmentioning

confidence: 99%

Retinal Detachment Associated With Giant Retinal Tears: Surgical Management and Outcomes in the Past 2 Decades

Varela

Morales

Díaz

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To describe the surgical outcomes of rhegmatogenous retinal detachments (RRDs) associated with giant retinal tears (GRTs) and define factors associated with primary anatomic failure. Methods: This retrospective consecutive study comprised primary GRT-RRD surgeries between 1999 and 2021 at a single institution. Exclusion criteria were a follow-up of less than 3 months and incomplete surgical data. Results: The series included 69 eyes (64 patients). Single-surgery anatomic success (SSAS) was achieved in 75% and final anatomic success (FAS) in 90%. The mean logMAR visual acuity improved from 1.5 ± 1.1 to 0.6 ± 0.9. Preoperative factors significantly associated with redetachment were proliferative vitreoretinopathy (PVR) (odds ratio [OR], 6.2; P < .01), hypotony (OR, 13.6; P < .01), and a 180-degree or larger GRT (OR, 3.3; P = .04). All cases were treated with pars plana vitrectomy (PPV) and perfluoro-N-octane (PFCL). Perfluoropropane (C3F8) was used in 59% and silicone oil in 41%; the redetachment rate was significantly lower in gas cases (15% vs 39%) ( P = .02). An encircling band, placed in 84% eyes, had a tendency to reduce redetachment (22% vs 36%) ( P = .32). Lensectomy was performed in 61% of phakic eyes, with no effect on redetachment (20% vs 21%) ( P = .92). On multivariate analysis, PVR and hypotony were significantly associated with redetachment. Conclusions: PPV with PFCL achieved high SSAS and FAS rates. PVR and hypotony were the main preoperative factors associated with anatomic failure. In cases without PVR, C3F8 tamponade significantly increased SSAS. Encircling scleral buckling showed a nonsignificant tendency toward an increase in SSAS. Lensectomy had no effect on SSAS.

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“…The mean age of patients presenting with a GRT is 34 to 53. [7][8][9][10][11][12][13][14][15] This finding may be influenced by the association with trauma, which is more common in younger individuals.…”

Section: Prevalencementioning

confidence: 99%

“…6 Patients with GRTs are predominantly male (55% to 91%) in most studies although one larger study reported a female predominance. [7][8][9][10][11] While ocular trauma has a significant male predominance and is the strongest risk factor for GRTs, the male predominance persists when traumatic GRTs are excluded. The mean age of patients presenting with a GRT is 34 to 53.…”

Section: Prevalencementioning

confidence: 99%

Giant Retinal Tears: A Review With a Focus on Trauma

Bleicher,

Miller

2024

International Ophthalmology Clinics

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Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments

Cited by 5 publications

References 37 publications

Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment

Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment

Retinal Detachment Associated With Giant Retinal Tears: Surgical Management and Outcomes in the Past 2 Decades

Giant Retinal Tears: A Review With a Focus on Trauma

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