Abstract
Purpose :
Though modern surgical techniques continue to improve outcomes in primary rhegmatogenous retinal detachment (RRD) repairs, management of inferior RRD remain more challenging with some suggesting that adding a scleral buckle (SB) during pars plana vitrectomy (PPV) improves results. We therefore compared anatomical and functional outcomes in inferior RRD repair using PPV only or PPV with SB (PPV-SB) in a retrospective cohort study.
Methods :
Patients operated for inferior RRD at the Centre hospitalier universitaire de Québec – Université Laval between 2014 and 2018 with a minimum three-month follow-up were included. Inferior RRD was defined as tears between 4:00 and 8:00 clock hours in detached retina. Exclusion criteria included: non-RRD etiologies (e.g., traumatic, tractional), proliferative vitreoretinopathy (PVR) grade ≥C2, and silicone oil use. Primary outcome was single surgery anatomic success (SSAS) defined as absence of reoperation for recurrent RRD in the operating room during follow-up.
Results :
There were 366 patients included of which 260 (71%) were operated using PPV-SB. Median [Q1, Q3] age was 63 [57, 70] years. There were 269 (74%) men, 207 (57%) pseudophakic, and 73/349 (21%) myopic with ≥4 diopters. Baseline PHVA was 0.54 [0.10, 1.30], 204 (56%) had a macula off RRD, and duration of symptoms was 7 [5, 15] days. Preoperative PVR was more frequent among PPV-SB patients (n=70, 27% vs. n=11, 10%; p<0.001) as were the number of tears and RRD quadrants involved (p<0.05).
Median follow-up was 15 [4, 31] months. SSAS was achieved in 96 (91%) of PPV patients and 227 (87%) of PPV-SB patients (p=0.38). Causes of recurrent RRD (i.e., PVR or new/recurrent tears) were not significantly different between groups. At final follow-up, PHVA was 0.18 [0.10, 0.40]. In multiple regression analyses using a backwards elimination strategy, adjusting for demographic (i.e., age and sex) and preoperative characteristics (i.e., macula off status and PVR), PPV-SB did not alter SSAS (p=0.197).
Conclusions :
Following inferior RRD repair, there were no significant differences in SSAS between patients undergoing PPV and PPV-SB. Though this did not change after multivariable adjustments, these results remain susceptible to confounding by indication among PPV-SB patients who may have been offered this surgery based on other preoperative risk factors not captured in this retrospective review.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.