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A. Tewari, G.K. Shah, A. Patel, M.S. Dhalla, S. Sharma; Management of Inferior Rhegmatogenous Retinal Detachments: Scleral Buckle vs. Combined Pars Plana Vitrectomy and Scleral Buckle . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5257.
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Inferior rhegmatogenous retinal detachments can be repaired by multiple techniques but unfortunately there is no consensus in the management. The aim of this study was to examine the outcomes of patients treated for primary inferior retinal detachments by scleral buckling (SB) alone and by combined pars plana vitrectomy and scleral buckling (PPV/SB) and to identify factors that may influence the outcomes.
Retrospective review of 85 consecutive cases of primary inferior rhegmatogenous retinal detachments treated between 2000 and 2002 by SB alone or combined PPV/SB. An inferior detachment was defined as the primary retinal break being located between 4–o’clock and 8–o’clock positions. Presenting visual acuity, anatomic status of the macula, and lens status were among the factors recorded. Visual acuity at most recent follow–up visit, in addition to any interventions in the post–operative period, including reoperations and cataract extraction, were noted. Statistical analysis with a linear regression model was performed.
Of 85 primary inferior rhegmatogenous retinal detachments, 29 (34%) were repaired by SB and 56 (66%) were repaired by PPV/SB. Mean follow–up was 16 months (range 10–24 months). In the SB group, 21 (72%) patients were phakic pre–operatively and no patients required cataract surgery in the postoperative period. There were 3 (10%) cases of redetachment that required reoperation. In the PPV/SB group, 19 (34%) patients were phakic pre–operatively and 14 (74%) required cataract surgery in the post–operative period. There were 4 (7%) cases of redetachment that required reoperation in the PPV/SB group. Of the 29 detachments repaired by SB only, 22 (76%) achieved vision ≥20/40. Of the 56 inferior detachments repaired by PPV/SB, 35 (63%) achieved vision ≥20/40. This difference was not statistically significant. A sub–analysis revealed that patients treated by PPV/SB were more likely to be macula–detached (33/56; 59%) than in the SB group (8/29; 28%).
Patients with inferior retinal detachments can be repaired by SB alone or PPV/SB, with both techniques giving comparable visual outcomes and reoperation rate. Although there is an overall increasing trend towards vitrectomy in retinal surgery, SB remains an excellent option for the repair of primary rhegmatogenous retinal detachments, especially in phakic patients.
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