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Yong S. Han, Hesu Yang, Ron A. Adelman; Comparison of Outcomes from Surgical Treatments for Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4615.
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To determine if there are any significant differences in anatomical and visual acuity outcomes among patients who have undergone the scleral buckle (SB), pars plana vitrectomy (PPV), combined vitrectomy with scleral buckle, or pneumatic retinopexy (PR) procedures for the treatment of rhegmatogenous retinal detachment (RRD).
A retrospective chart review was done on all patients who had their initial surgery for RRD at Yale Eye Center. The search yielded 166 eyes from 155 patients. Nine surgeons were involved, although two surgeons performed operations on 124 eyes. The patients were divided into 4 groups based on the type of their surgical treatment. Their status as phakic or pseudophakic, macula-on or macula-off RRDs at the time of surgery was recorded. After collecting data on patients’ retinal re-attachment rates, recurrence of detachment, visual acuity at 3 months, 6 months, and 1 year post-surgery, chi-square and Fischer exact tests were used to determine if there were significant differences in the outcomes among the treatment groups.
Patients who had undergone the combined SB and PPV procedure had the highest attachment rate within 1 month post-surgery (44 out of 45 eyes, or 97.8%), followed by SB (57/59, or 96.6%), PPV (23/25, or 92.0%), and PR (32/37, or 86.5%). The differences were not statistically significant by the Fischer exact test (p=0.1270). The rates of recurrence of RRD by treatment also did not differ significantly (p=0.319), but PPV was found to have the highest rate of recurrence at 30.4% (7 out of 23 eyes), followed by PR at 28.1% (9/32), combined SB and PPV at 25.0% (11/44), and SB at 19.3% (11/57). Visual acuity changes (in logMAR values), measured as the difference between initial acuity at presentation with RRD before surgery and post-surgery at 3 months, 6 months, and 1 year showed no significant differences among treatment groups (p-values on the F-statistic for linear models of the treatment vs. improvement in visual acuity were 0.53 for 3 months, 0.67 for 6 months, and 0.12 for 1 year). Finally, separating patients based on whether they were phakic or pseudophakic, or whether they had macula-on or macula-off RRD at the time of surgery did not result in significant differences among treatment groups.
For patients with RRD, it appears that other factors, such as the surgeon’s technique, may be more important in determining patient outcome than the type of surgery performed.
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