title: Management of retinal detachment when no break is found.
abstract: OBJECTIVE
  To review the results of 2 different surgical approaches in the management of primary rhegmatogenous retinal detachments (RDs) with undetected retinal breaks.
  
  
  METHODS
  Retrospective, consecutive, interventional case series.
  
  
  METHODS
  Medical records of 44 patients with uncomplicated macula-involving primary rhegmatogenous-appearing RDs, but without retinal breaks detected preoperatively or intraoperatively, were reviewed.
  
  
  METHODS
  All study patients were operated by the same surgeon between 1989 and 2004 using 2 approaches: 26 (59%) patients underwent a scleral buckling procedure (SBP) with or without subretinal fluid drainage, whereas 18 (41%) patients underwent scleral buckling combined with pars plana vitrectomy (PPV), fluid-gas exchange, and broad application of endolaser.
  
  
  METHODS
  Single operation and final postoperative anatomic success, and 2-month postoperative and final best-corrected visual acuity (VA) (negative logarithm of the minimum angle of resolution [logMAR]).
  
  
  RESULTS
  Mean preoperative VAs were 1.73 logMAR units (median, 1.60; range, 0.48-2.60) in the combined surgery group and 1.52 logMAR units (median, 1.30; range, 0.30-2.60) in the scleral buckling group. Neither preoperative (P = 0.33), 2-month postoperative (P = 0.53), best-corrected (P = 0.98), nor final (P = 0.46) mean VA showed any statistically significant differences between the 2 treatment groups. A single operation reattachment rate of 72% (13/18 cases) was achieved in the combined surgery group, compared with 61.5% (16/26 cases) in the scleral buckling group (P = 0.17, log rank test). Immediate anatomic success rates were 89% after combined treatment and 38.5% after scleral buckling alone (P = 0.002). At the final visit, the retina was attached in 15 (83.3%) patients who received the combined treatment and in 22 (84.6%) patients who underwent scleral buckling (P = 0.900). Intraoperative subretinal hemorrhage occurred in 1 (5.6%) patient from the combined surgery group and in 2 (7.7%) patients from the scleral buckling group. Retinal incarceration in the drainage sclerotomy occurred in 1 (3.8%) case during the SBP. Proliferative vitreoretinopathy sufficient to require reoperation developed in 1 (5.6%) eye of the combined surgery group and in 3 (11.5%) eyes of the scleral buckling group.
  
  
  CONCLUSIONS
  Scleral buckling is as effective in the management of uncomplicated rhegmatogenous RDs with undetected breaks as is surgery combining scleral buckling and PPV.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101-6880, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Salicone
authors.forename: William E
authors.initials: WE
authors.lastname: Smiddy
authors.forename: Anna
authors.initials: A
authors.lastname: Venkatraman
authors.forename: William
authors.initials: W
authors.lastname: Feuer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D012167:Retinal Perforations / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D012591:Scleral Buckling / Q000009:adverse effects; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects