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Anton Orlin, Nina J. Jonsson, Aalya H. Fatoo, Michael Nissen, Robison V. Chan; 23- or 20-gauge Pars Plana Vitrectomy Alone vs Combined Pars Plana Vitrectomy and Scleral Buckle for the Treatment of Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6171.
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To compare long term results of pars plana vitrectomy (PPV) alone vs vitrectomy combined with scleral buckle (PPV/SB) in the treatment of primary rhegmatogenous retinal detachment (RRD).
Retrospective, nonrandomized chart review of all patients receiving primary PPV (20 or 23 gauge) or PPV combined with an encircling 41 band for the treatment of RRD between 2006 and 2010. All surgeries were performed by 2 retinal surgeons at Weill Cornell Medical College. Thus far, 11 eyes undergoing PPV alone and 19 eyes undergoing PPV/SB have been included in the study. Eyes were excluded if the duration of follow up was less than 3 months, or if they had received prior surgery for RRD. Main outcome measures were single surgery anatomic success rates, visual acuity changes, and post operative complications.
54.55% of eyes in the PPV group presented with macula off retinal detachments compared to 68.42% in the PPV/SB group (p=0.465). At baseline, eyes in the PPV group vs PPV/SB groups were recorded as having identifiable retinal breaks (100% vs 73.68%, p= 0.066), proliferative vitreoretinopathy (PVR) (18.18% vs 42.11%, p=0.193), and inferior retinal breaks (9.00% vs 42.11%, p=0.60). At a mean follow up of 431 days, the single surgery success rate of reattachment was 72.72% in the PPV alone group vs. 89.47% in the PPV/SB group (p=0.25). At follow up, the PPV group showed a mean improvement in visual acuity by 0.8 logMAR units, while the PPV/SB group improved by 0.69 logMAR units (p=0.788). Subsequent surgery included epiretinal membrane removal (1 eye-PPV group), corneal transplant for edema (1 eye-PPV/SB group), and cataract extraction (1 eye- PPV group, 3 eyes-PPV/SB group).
There was no statistically significant difference in visual improvement, or in single surgical success rate between the PPV and PPV/SB groups. There was a trend amongst eyes in the PPV/SB group (on initial examination) to have more PVR, more inferior retinal breaks, and less identifiable retina breaks. An increased number of eyes will be included into the study over the near future.
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