Is It Necessary to Add a Scleral Buckle When Doing a Pars Plana Vitrectomy for Primary Repair of Rhegmatogenous Retinal Detachment? The Retina 1 Project, Report 3

Abstract

Purpose: : The use of a scleral buckle (SB) added to a PPV as a surgical procedure for treating rhegmatogenous retinal detachment (RD) is a matter of controversy. The use of a SB might improve the anatomical success, but it is time consuming and could be a source of complications. Retina 1 project is a prospective multicenter study in 18 centers of Spain and Portugal collecting patients with RD to improve the prediction of patients who will develop a proliferative vitreoretinopathy. Using some of the collected data, this study tries to elucidate if the addition of a SB to PPV will improve the anatomical results of surgery for RD.

Methods: : Prospective, non-randomized, interventional comparative study with data from consecutively treated RD from January 2005 to May 2007. Cases with pre-operative PVR grade C-1 or higher and perforating trauma were excluded. Minimum follow-up was 3 months. Surgeons were free to choose the surgical technique they considered more appropriate. Only patients that underwent primary pars plana vitrectomy were included. Logistic regression models were used to evaluate the relationship between pre- and intra- surgical variables and anatomical success.

Results: : Data from 514 RD in phakic and pseudophakic patients were analysed. Group 1 had 245 patients treated only with PPV and Group 2 had 269 patients treated with SB and PPV. Global anatomic success rate after a single procedure was 89.88% without differences between both groups. Surgeons decided to use VPP plus SB more frequently in RD on phakic patients, when multiple, posterior o no breaks were identified, in case of posterior vitreous attachment and more extended RD. Logistic regression analysis showed that adding a SB to PPV did not improve the anatomical results in any of the clinical categories above mentioned. Moreover, phakic patients with posterior vitreous detachment, had a statistically better anatomical results in group 1.

Conclusions: : Our data do not support the benefits, in terms of anatomical success, of adding a SB to a PPV in any specific group of patients for primary repair of rhegmatogenous RD.

Keywords: retinal detachment • vitreoretinal surgery