Abstract
Purpose :
The mainstay of treatment for uncomplicated rhegmatogenous retinal detachment (RRD) has been surgical intervention using various techniques often decided at the level of individual surgeons. While previous research suggests certain approaches may yield better outcomes based upon pre-operative characteristics such as lens status, a superior method has not been elucidated. We performed a retrospective, observational study comparing the outcomes of primary RRD repair using pars plana vitrectomy (PPV), scleral buckling (SB), or combined SB with PPV (SB/PPV).
Methods :
179 patients between 2015-2020 with RRD managed at a large university hospital system were included. Outcome measures included: primary anatomical success rate, improvement in best-corrected visual acuity (BCVA), and functional success rate. Primary success was classified as maintained anatomical integrity of the retina following one intervention measured 6 months postoperatively. Functional success was defined as measuring a postoperative BCVA of 20/200 or better. BCVA was converted to logMAR for comparison between groups. Statistical analysis was performed using the chi-square test and ANOVA. We excluded patients with: less than 6 months of follow-up, previous retinal surgery, giant retinal tears, aphakia, secondary forms of RRD, or extensive proliferative vitreoretinopathy.
Results :
SB/PPV yielded the best results in each outcome measure. Primary anatomical success was achieved in 147 of the 179 eyes (82.1%), with SB/PPV showing the greatest success rate (90.3%; p=0.15) amongst the interventions. Functional success was achieved in 125 of the 179 eyes (69.8%), with SB/PPV showing significantly greater functional success (83.9%; p=0.02) than SB (60.0%). SB/PPV showed significantly greater improved mean BCVA (0.87; p=0.04) when compared to SB (0.40); this result held in sub-group analysis of phakic eyes.
Conclusions :
SB/PPV yielded the best results for primary anatomical success, functional success, and BCVA improvement out of the three interventions studied. SB/PPV showed significantly better functional success rates (p=0.02) and mean BCVA improvement (p=0.04) when compared to SB. In phakic patients, SB/PPV showed significantly greater BCVA improvement (p=0.03) when compared to SB.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.