An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment.
OBJECTIVE
To evaluate the various surgical interventions available for uncomplicated rhegmatogenous retinal detachment.


METHODS
Reports of controlled clinical trials of surgical interventions (pneumatic retinopexy, scleral buckling and vitrectomy) for uncomplicated rhegmatogenous retinal detachment indexed in MEDLINE from 1968 to January 2006 were included. The primary outcomes evaluated included single-operation reattachment rates, multiple reoperation reattachment rates and improvements in visual acuity (VA).


RESULTS
We found five controlled trials (two randomized) comparing the efficacy of pneumatic retinopexy versus scleral buckling. The single-operation reattachment rates were higher for scleral buckling, but the final reattachment rates were similar. We found nine controlled trials (four randomized) evaluating vitrectomy. There were no statistically significant differences between retinal reattachment rates or final visual acuities, except in one randomized and one non-randomized controlled trial in which the VAs were significantly better in the vitrectomy than the scleral buckling group.


CONCLUSIONS
Pneumatic retinopexy is a possible alternative to scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment. The rates of missed or new retinal breaks after pneumatic retinopexy, however, are higher than following scleral buckling. The clinical outcomes of vitrectomy for rhegmatogenous retinal detachment compare favourably.
Saw
Seang-Mei
SM
Department of Community, Occupational and Family Medicine, National University of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. cofsawsm@nus.edu.sg
Gazzard
Gus
G
Wagle
Ajeet M
AM
Lim
Jimmy
J
Au Eong
Kah-Guan
KG
D017679:Cryotherapy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D012163:Retinal Detachment / Q000601:surgery*; D012591:Scleral Buckling / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*