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Aaron Parnes, Didier Ducournau, Jack Sipperley, Ron Adelman, European Vitreo-Retinal Society (EVRS) Retinal Detachment Study Group; Strategy for the Management of Complex Retinal Detachments: The European Vitreo-Retinal Society Retinal Detachment Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2846. doi: https://doi.org/.
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To study the outcome of the treatment of complex rhegmatogenous retinal detachments.
In this non-randomized, multi-center retrospective study, 176 surgeons from 48 countries spanning 5 continents provided information regarding the primary procedures for 7,678 rhegmatogenous retinal detachments. Reported data included clinical manifestations, the method of repair, and the outcome following treatment.
The main categories of complex retinal detachments evaluated in this investigation are those associated with: 1) Grade B PVR (n = 917), 2) Grade C-1 PVR (n = 637), 3) choroidal detachment or significant hypotony (n = 578), 4) large or giant retinal tears (n = 1,167), and 5) macular hole detachments (n = 153). In detachments with Grade B PVR, the final failure rate was higher when treated with a scleral buckle alone versus vitrectomy (p=0.0017). In cases with Grade C-1 PVR, there was no statistically significant difference in the final failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (p = 0.7). Those that received vitrectomy with a supplemental buckle had an increased failure rate compared to those that did not receive a buckle (p = 0.007). There was no statistically significant difference in final failure rate between tamponade with gas versus silicone oil in patients with Grade B or C1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (p = 0.0015). Cases with large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (p = 7 x 10 -8).
In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, this data suggests that a supplemental buckle may not be helpful.
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