title: 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.
abstract: 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.
authors.affiliation: Ophthalmic Research Center, Labbafinejad Medical Center, Tehran, Iran. hahmadieh@hotmail.com
authors.forename: Hamid
authors.initials: H
authors.lastname: Ahmadieh
authors.forename: Siamak
authors.initials: S
authors.lastname: Moradian
authors.forename: Hooshang
authors.initials: H
authors.lastname: Faghihi
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Parvaresh
authors.forename: Heshmatollah
authors.initials: H
authors.lastname: Ghanbari
authors.forename: Morsal
authors.initials: M
authors.lastname: Mehryar
authors.forename: Ebadollah
authors.initials: E
authors.lastname: Heidari
authors.forename: Hasan
authors.initials: H
authors.lastname: Behboudi
authors.forename: Touka
authors.initials: T
authors.lastname: Banaee
authors.forename: Banafsheh
authors.initials: B
authors.lastname: Golestan
mesh_terms: 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*