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Rayan Alshareef, Mohammed Khuthaila, Philip Storey, Richard Kaiser, Benjamin Leiby, Nikolas London, Natalie Fang-Yen; Scleral buckling versus primary vitrectomy in patients with rhegmatogenous retinal detachment at high risk for proliferative vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2870.
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To compare primary pars plana vitrectomy (PPV) to band scleral buckle (SB) with or without PPV for primary repair of rhegmatogenous retinal detachments (RRD) in patients at high risk for proliferative vitreoretinopathy (PVR).
In a retrospective, nonrandomized, comparative intervention study, 678 patients from one retina practice were identified from billing data as having a RRD occur between April 1, 2010 and August 1, 2012. Patients were considered at high risk for PVR if they presented with retinal detachment (RD) in 2 or more quadrants, retinal tears larger than 1 clock hour, baseline PVR grade A-C, vitreous hemorrhage, or an RD associated with trauma. Patients with less than 3 months follow-up were excluded.
Seventy-Five patients were identified as being at high risk for PVR and were followed for a mean of 6 months. A group of 16 surgeons performed PPV alone on 31 patients and band SB (86% with a combination PPV) on 44 patients. Patients treated with band SB were significantly more likely to have anatomic success after a single surgery compared to those treated with PPV (Odds ratio 3.60; 95% CI 1.37 - 9.47). Overall, the single surgery anatomical success rate was 65%; 75% for SB with or without PPV and 52% for PPV alone (p=0.036).. Best-corrected visual acuity (BCVA) at 3 months post-procedure, BCVA at final follow-up and development of PVR was not significantly different between the two treatment groups. Overall, 22% of patients developed PVR.
For patients at high risk for PVR, band SB was associated with signficiantly higher anatomical success rates compared to PPV. There was no significant difference in BCVA at 3 months post-procedure or final follow-up. The overall success rate for high-risk eyes was 75% for band SB and 52% for primary vitrectomy.
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