Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation--report no. 1.
OBJECTIVE
To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment.


METHODS
Prospective, randomized, multicenter clinical trial.


METHODS
Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment.


METHODS
Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle.


METHODS
Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia.


RESULTS
There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73-2.24), indicating no statistically significant difference. Proliferative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications.


CONCLUSIONS
Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation.
Ahmadieh
Hamid
H
Ophthalmic Research Center, Labbafinejad Medical Center, Tehran, Iran. hahmadieh@hotmail.com
Moradian
Siamak
S
Faghihi
Hooshang
H
Parvaresh
Mohammad M
MM
Ghanbari
Heshmatollah
H
Mehryar
Morsal
M
Heidari
Ebadollah
E
Behboudi
Hasan
H
Banaee
Touka
T
Golestan
Banafsheh
B
D001036:Aphakia, Postcataract / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000150:complications*; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery*; D012591:Scleral Buckling / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy / Q000379:methods*