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Julian J. Venero, Valeiras Marcelo, Garibotto Martin, Rubin Uriel, Daponte Andres, De Michelis Veronica, Badia Jose Alberto, Iribarren Guillermo; Comparison Between Two Surgical Techniques For The Resolution Of Medium Complexity Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6173.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the anatomical and functional success of two different surgical techniques for the treatment of rhegmatogenous retinal detachment (RD) of medium complexity, using complete retinal reattachment and best corrected visual acuity (BCVA) as parameters.
Retrospective analysis of medical records from 64 patients (66 eyes) which were operated on for rhegmatogenous RD between January 2007 and December 2009 by 4 different retinal surgeons. The patients were divided to undergo scleral explant or pars plana vitrectomy at the discretion of the surgeon, based on the complexity of the retinal detachment. Forty-two patients (44 eyes, 66.6%) in group 1 received scleral explant as primary procedure. Twenty two eyes from 22 patients (33.4%) in group 2 underwent pars plana vitrectomy (PPV) as primary procedure. Fourteen eyes in group 2 (63.6%) required the addition of a circular silicone sponge explant during the first procedure.
In group 1, success was achieved with only one procedure in 30 patients (68.2%), while 14 patients (31.8%) required a second procedure. Of the 14 patients in whom the first surgery failed, 9 (64.28%) underwent PPV as a second procedure, and 5 (35.72 %) were re-operated on to relocate the explant. In group 2, anatomic success was achieved in 17 patients (77.3%) and retinal reattachment failed in 5 patients (22.7%). Four of the failures (80%) were due to Vitreo Retinal Proliferation (VRP) and required the use of silicone oil tamponade, while the other patient (20%) needed explant relocation because the tear was not in the explant area.
We conclude that primary vitrectomy has a higher success rate than the conventional method for the resolution of medium complexity RD. BCVA improvement was better in group 2 (0.22) than group 1 (0.05). This difference is significant in phakic patients of group 2 (gain 0.42) compared to phakic patients of group 1 (gain 0.07). While many studies sugest scleral bucle as a better option in phakic patients, they measure the anatomic but not functional outcome.
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