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S Martinez-Jardon, V Morales-Canton, R Magdalenic, J Sinisterra, C Araya-Muñoz, H Quiroz-Mercado; Pars Plana Vitrectomy Versus Scleral Buckling for Primary Rhegmatogenous Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2002;43(13):619.
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Purpose:To compare the anatomic and visual outcomes achieved by pars plana vitrectomy (PPV) and scleral buckling (SB) for the treatment of uncomplicated primary rhegmatogenous retinal detachment (PRRD). Methods:In a prospective, longitudinal descriptive and experimental study, eight consecutive patients of both genders with PRRD eligible for treatment with SB and no more than proliferative vitreo-retinopathy grade B, where enrolled. They were randomly assigned to PPV using a high speed (1200 cpm) vitrectomy hand piece, endolaser and gas tamponade (20% SF6) or to SB procedure. Surgery success rate (complete reattachment three months following surgery), complications rate, as well as changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), ocular axial length, multifocal electroretinography (mERG), optic coherence tomography (OCT) and patient’s discomfort were recorded and compared between the two surgical techniques. Results:Eight phakic eyes of eight patients were included (four in each group). In the PPV group, ages ranged between 20 and 65 years (mean 45). Three eyes had a macula-off detachment. Initial BCVA ranged from hand motion to 20/100. Primary reattachment was achieved in all cases. One eye re-detached two weeks after surgery and subsequently underwent a successful combined buckling and vitrectomy surgery. Final visual acuity improved in all cases (1.75 line on average), and ranged between 20/200 to 20/70. Two patients had elevated ocular pressure, controlled by topical antihypertensives. Posterior subcapsular cataract developed in two eyes. In the SB group, patients ages ranged between 14 and 52 years (mean 37). Initial BCVA ranged from 20/400 to 20/200. Four had a macula-off detachment. Reattachment was achieved in all cases. Final visual acuity improved in all cases (3.75 lines on average) and ranged from 20/200 to 20/30. Extraocular muscle imbalance and diplopia developed postoperatively in one patient. OCT indicated normal postoperative retinal thickness range in both groups eyes. mERG amplitudes improved postoperatively in all eyes. No difference in improvement rate or amplitudes was found between the two groups. Patient’s postoperative discomfort was similar in both groups. Conclusion:This study results suggest that although both techniques are anatomically and functionally effective for the treatment of uncomplicated PRRD, SB procedure may be associated with higher primary success and lower postoperative complication rates.
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