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Vitrectomy vs. Combined Vitrectomy and Scleral Buckle for Repair of Primary Rhegmatogenous Retinal Detachment with Vitreous Hemorrhage

Published:October 07, 2021DOI:https://doi.org/10.1016/j.oret.2021.10.001

      Abstract:

      Objective

      To compare pars plana vitrectomy (PPV) to PPV with scleral buckle (PPV/SB) for repair of primary rhegmatogenous retinal detachment (RRD) with associated vitreous hemorrhage (VH).

      Design

      Retrospective, observational study.

      Subjects

      Patients with RRD and associated VH who underwent PPV or PPV/SB from January 1, 2010 through August 31, 2020 were analyzed.

      Methods, Intervention, or Testing

      We performed a single-institution, retrospective, observational study of 224 eyes with RRD and VH at the time of detachment. We excluded eyes with less than 6 months of follow up, prior history of retinal detachment repair with vitrectomy or scleral buckle, VH that resolved before surgical intervention, tractional or combined tractional and rhegmatogenous detachment.

      Main Outcome Measures

      Single surgery anatomic success (SSAS) at 6 months, defined as no recurrent retinal detachment requiring surgical intervention.

      Results

      PPV and PPV/SB were performed on 138 eyes (62%) and 85 eyes (38%), respectively. The mean age was 61.9 years in PPV patients and 60.2 years in PPV/SB patients. Single-surgery anatomic success was achieved in 107 of 138 (77.5%) eyes that underwent PPV and in 78 of 85 (91.7%) eyes that underwent PPV/SB. The difference in SSAS between types of treatment was significant (p = 0.006). Mean visual acuity improvement in the PPV/SB group was 0.54 logMAR units greater than the PPV group (p = 0.126). The incidence of postoperative PVR in the PPV/SB group (11.7%) was lower than in the PPV group (19.5%) (p = 0.128). The rate of repeat PPV for non-RD reasons was similar for both groups (p = 0.437). Final reattachment status was achieved in 137 of 138 and 84 of 85 eyes in the PPV and PPV/SB groups, respectively. Final visual acuity improvement was significantly better in eyes with PPV/SB compared to PPV alone (logMAR 2.12 vs 1.26; p=0.011).

      Conclusions

      In RRD with VH patients, SSAS was superior in patients treated with PPV/SB compared with PPV alone. Although not significantly different, the PPV/SB group had better visual outcomes and a lower postoperative PVR rate.
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