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Ron Adelman, Aaron Parnes, Didier Ducournau, European Vitreo-Retinal Society (EVRS) Retinal Detachment Study Group; Management of Uncomplicated Retinal Detachments: A Multicenter Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4953.
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To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments.
Non-randomized, multi-center clinical study. 7,678 rhegmatogenous retinal detachments were included in the study. 176 surgeons from 48 countries spanning 5 continents provided information on the primary procedures for these patients. Reported data included specific clinical findings, the method of repair, and the outcome following intervention. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). MAIN OUTCOME MEASURES: Failure of retinal detachment repair, remaining silicone oil, and need for additional procedures to repair the detachments.
Of the 7,678 cases of rhegmatogenous retinal detachment, 4,179 “uncomplicated” retinal detachments were included in this report. Combining phakic, pseudophakic, and aphakic groups, those that were treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2717) (p = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group as compared to those who had vitrectomy, with or without a supplemental buckle (p = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in vitrectomy compared to scleral buckle (p = 3 x 10-8). There was no statistically significant difference in failure rate between segmental (n= 721) and encircling (n= 351) buckles (p = 0.5). Those that received vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared to those that had vitrectomy without a supplemental buckle (n = 2242) (p = 0.048).
In the treatment of “uncomplicated” phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360 degree buckle. For pseudophakic “uncomplicated” retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, this data suggests that a supplemental buckle is not helpful.
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