Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment

Outcomes in Recurrent Rhegmatogenous Retinal Detachment Repair: Does Scleral Buckling at Primary or Secondary Surgery Impact Results?

Background/Objectives

To analyze outcomes in recurrent rhegmatogenous retinal detachment (re-RRD) repair using pars plana vitrectomy (PPV) combined with scleral buckle (SB) at the first or second surgery.

Subjects/Methods

Patients with primary uncomplicated RRD at initial presentation who were operated for re-RRD between 2014 and 2018 were included in this retrospective cohort study (n = 127). Patients were compared based on first and second surgery sequence: PPV then PPVSB (PPV-PPVSB: n = 51, 40%), or PPVSB then PPV (PPVSB-PPV: n = 76, 60%). Anatomical and functional outcomes were evaluated with second surgery success (2SS) defined as absence of reoperation after the second surgery and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR), respectively.

Results

Mean age at initial presentation was 65.7 years. There were 78 (61%) men and 56 (44%) pseudophakic patients. Median [Q1, Q3] baseline PHVA in logMAR was 0.70 [0.18, 2.30]. SB at first or second surgery did not significantly alter 2SS (PPV-PPVSB: 38, 75% vs PPVSB-PPV: 57, 75%; p = 1.00) or silicone oil use at second surgery (PPV-PPVSB: 18, 35% vs PPVSB-PPV: 36, 47%; p = 0.40). At final follow-up, PHVA did not significantly differ by sequence (p = 0.16).

Conclusion

In re-RRD repair, SB at first or second surgery did not alter 2SS and final PHVA.

Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle

PURPOSE

To compare outcomes following primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).

METHODS

This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated RRD repaired using PPV only or PPV-SB (full cohort: n=1516, propensity-matched cohort: n=908). The primary outcome was single surgery anatomic success (SSAS), while secondary outcomes were 3-month and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR) and final retina status.

RESULTS

In the full cohort, SSAS was achieved in 745 (91%) of PPV patients vs. 623 (89%) of PPV-SB patients (p=0.13). This was 390 (92%) vs. 314 (88%) in phakic patients (p=0.06) compared to 353 (91%) vs. 301 (90%) in pseudophakic patients (p=0.79), respectively. After matching, SSAS was achieved in 424 (93%) of PPV patients vs. 412 (91%) of PPV-SB patients (p=0.14). Median PHVA after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: p<0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: p<0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: p<0.001).

CONCLUSION

Addition of SB does not significantly change the rate of SSAS compared to PPV only in primary uncomplicated RRD. It is also associated with worse PHVA at follow-up.