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P.N. Dayani, K.J. Blinder, G. Shah, M.A. Thomas, D.P. Joseph, N.M. Holekamp, M.G. Grand; Surgical Outcome of Scleral Buckle Compared With Scleral Buckle With Vitrectomy for the Treatment of Macula–Off Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1462.
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To compare surgical outcome of scleral buckling (SB) procedure (Group I) versus scleral buckle plus pars plana vitrectomy (PPV) (Group II) for the repair of macula–off rhematogenous retinal detachment (RRD), in the absence of proliferative vitreoretinopathy (PVR).
A retrospective chart review was carried out. Surgical outcome was defined as best and most recent visual acuity, as well as the need for additional surgery. Inclusion criteria included macula–off RRD detachment of known duration in patients 16 years or older, with follow–up of three or more months. Exclusion criteria included patients with known ocular disease limiting potential visual potential, any degree of PVR, trauma, history of prior detachment, endophthalmitis, retained lens fragments, or incomplete charting.
A total of 146 patients were identified, 83 patients were included in Group I and 64 patients in Group II. Presenting demographics and findings were comparable with the exception that more patients in Group II were pseudophakic. Presenting visual acuity was 4/200 and 3/200 in Group I and II, respectively. Median duration of detachment prior to surgery was 5 days in Group I and 6 days in Group II. There was no statistical difference in best or most recent visual acuity between the two groups. Median best visual acuity was 20/30 and median most recent vision was 20/40 in both groups. Significantly more additional procedures were performed in Group I (21.7% vs. 7.9%). Final reattachment rate was 96.4% in Group I and 98.4% in Group II. Difference in the development of PVR approached statistical significance (14.5% in Group I and 4.8% in Group II). (Chi–square 0.056) Poor presurgical visual acuity correlated with decreased best and most recent visual acuity. Duration of detachment was not associated with surgical outcome or the development of PVR in either group or in the combined data. Phakic status did not affect visual outcome in either group. PVR correlated inversely with best visual acuity (Chi–square 0.0002) and most recent vision (Chi–square <0.0001), and was associated with increased need for additional procedures (Chi–square <0.0001). All measures of surgical outcome were adversely affected by advanced age.
Visual outcome of SB is similar to SB plus PPV for the treatment of macula–off RRD in patients presenting without PVR. Patients undergoing SB only, however, are at increased risk of developing PVR and requiring additional procedures.
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