Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment

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Purpose

To compare primary pars-plana vitrectomy (PPV) alone vs vitrectomy with an encircling scleral buckling procedure for the treatment of primary rhegmatogenous pseudophakic retinal detachment (PsRD).

Design

Prospective, nonrandomized, comparative study.

Methods

All 71 eyes of 68 consecutive patients with PsRD presented to our service between 1998 and 2002 were offered either vitrectomy alone (group-A) or vitrectomy in combination with encircling scleral buckling procedure (group-B). Preoperative and postoperative patient characteristics were recorded in detail. Main outcome measures were reattachment with a single surgery, visual acuity, and reattachment surgery-related complications.

Results

Retina reattachment with a single surgery was achieved in 97.78% in group A and 92.31% in group B. Visual acuity improved by 3 or more lines in 60% in group A and 69% in group B. Mean postoperative refractive error change (spherical) was −0.05 diopters in group A and −1.43 diopters in group B. Postoperative intraocular pressure on long-term follow-up was elevated in 4.44% (group A) and 34.61% (group B). Average follow-up was 12.45 months (±5.23 SD) ranging from 9 to 40 months. We detected additional breaks intraoperatively in 54.9% of cases (both groups).

Conclusions

Vitrectomy is an effective initial treatment for PsRD, whereas the benefit of an additional encircling buckling procedure is questionable.

Section snippets

Design

We conducted a prospective, nonrandomized study to compare PPV alone vs combined PPV with an encircling scleral buckling procedure, for the treatment of PsRD.

Patients and methods

We developed a protocol to treat all patients presenting to the Retina Service of the Geneva University Clinic of Ophthalmology, with PsRD between 1998 and 2001. According to this protocol, 71 eyes of 68 consecutive patients with PsRD were treated with either PPV alone (group A) or PPV in combination with an encircling scleral buckling procedure (group B). In the first 26 consecutive cases, PPV was combined with an ESB procedure (group B) with a desired moderate buckling effect. In the

Results

Forty-five eyes comprised group A, whereas group B included 26 eyes. Preoperative patient characteristics are shown in Table 1. Analytically, 50 men (70.42%) and 21 women (29.58%) comprised our study population. The mean patient age at RD diagnosis was 65.7 (±10.32 standard deviation [SD]) years, ranging from 44 to 93 years. Mean follow-up time was 12.45 (±5.23 SD) months (range: 9 to 40 months). In 57 cases (80.28%) phacoemulsification was the cataract surgery procedure, whereas 14 cases

Discussion

During the last decade, a substantial improvement has been made in cataract management, owing to novel IOLs and viscoelastics, more sophisticated surgical tecnicques, and state-of-the-art phacoemulsification apparatus. Nevertheless, PsRD is among one of the most serious cataract operation-related complications. 1, 2, 3 Since the first series 4 reporting PsRD, many questions remain unanswered regarding the causes of this frustrating condition and, although various predisposing and

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