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A.V. Arya, V.Y. Njike, C.L. Hagedorn, M. Engelbert, R. Adelman; Anatomical and Functional Outcome With Various Surgical Techniques in the Management of Pseudophakic Retinal Detachments . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5475.
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Purpose: To study success rates of pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV and SB in the management of pseudophakic retinal detachments. Methods: A meta–analysis was performed on the selected articles comparing anatomical and visual results following PPV, SB, and combined PPV and SB techniques in pseudophakic retinal detachments. We retrieved 404 articles from literature by Medline and manual searches. We included only those articles where enough data on preoperative evaluation, surgical methodology applied, and details of reattachment rates and visual results were available, and the outcome measures were clearly stated based on the type of surgical intervention in the included studies. Various studies on management of pseudophakic retinal detachments with pneumatic retinopexy were excluded from this analysis. Twenty seven papers matched the inclusion criteria. Results: Out of 2416 patients involved in meta–analysis, 1692 patients had a buckling procedure, 553 underwent PPV, and 171 had combined SB and PPV as the initial procedure. Retinal reattachment rate following first surgery was higher following PPV than SB [90.78% vs. 81.32%; p<0.0001]. Visual outcome as measured by either improvement or maintaining preoperative Snellen acuity, was also better following PPV than SB [88.25% vs. 60.89%; p<0.0001]. Combined PPV and SB in pseudophakic retinal detachments achieved the highest reattachment rate after one procedure in comparison to either PPV or SB alone [Combined=97.08%, PPV=90.78%; p=0.0070], [Combined=97.08%, SB= 81.32%; p<0.0001]. Final functional outcome as measured by maintaining preoperative visual acuity or improvement of at least one line on the Snellen chart was also better following combined technique than either technique alone [Combined=94.15%, PPV=88.25%; p=0.0268], [Combined=94.15%, SB=60.89%; p<0.0001]. Conclusions: In pseudophakic retinal detachments PPV has more favorable anatomical and visual outcomes compared to SB. The odds of retinal reattachment, and improvement in visual acuity after one procedure are highest following combined PPV and SB.
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