Abstract
Purpose :
The optimal procedure to manage simple rhegmatogeneous retinal detachment (RRD) is still debated. We performed a retrospective, propensity-matched cohort analysis to compare primary repair failure and final visual acuity (VA) following rhegmatogeneous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) only or PPV with scleral buckle (PPV-SB).
Methods :
Chart review was done of all 1516 consecutive patients operated for uncomplicated RRD repair using PPV (n=816) or PPV-SB (n=700) and sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) at a tertiary care center between 2014 and 2018. Patients with other etiologies of RD were excluded. Choice of procedure was at the discretion of the treating surgeon. We used a propensity score to obtain a 1:1 nearest-neighbor matching with a caliper of 0.2 accounting for age, sex, laterality, lens status, myopia, macula status, number of detached quadrants and tears, presence of inferior RD and tears, symptoms duration, visual acuity (VA) at baseline, and tamponade agent. Patients with missing data were excluded.
Results :
After matching, both groups (n=368 in each group) were well balanced for baseline characteristics, tamponade agent used, and follow-up durations. At presentation, patients had symptoms for 12.2±14.8 days and 2.6±0.8 quadrants were affected with 2.1±1.5 retinal tears. Most patients were macula-off (n=443, 60%) and baseline VA in logMAR was 0.99±1.09. Treatment mostly used SF6 (n=581, 79%).
Mean follow-up was 15.6 months. There were less recurrences of RRD in the PPV group (PPV: n=18, 5% vs. PPV-SB: n=41, 11%; p=0.002). More surgeries per patient were required to correct these recurrences in the PPV-SB group (PPV: 1.06±0.28 surgeries vs. PPV-SB: 1.14±0.42; p=0.002). Proliferative vitreoretinopathy and/or epiretinal membrane as a cause of recurrence was higher in the PPV-SB group (PPV: n=10, 3% vs. PPV-SB: n=26, 7%; p=0.006). VA in the PPV group was better at 3 months (PPV: 0.38±0.47 vs. PPV-SB: 0.47±0.50; p<0.001) and final follow-up (PPV: 0.27±0.33 vs. PPV-SB: 0.35±0.49; p=0.009).
Conclusions :
Following uncomplicated primary RRD repair, there were less recurrences and better VA at follow-up in patients who underwent PPV only compared to PPV-SB.
This is a 2021 ARVO Annual Meeting abstract.