title: Surgical management of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To examine possible differences in clinical outcomes between pars plana vitrectomy (PPV) and scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD).
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Adult patients with uncomplicated RRD from previously reported randomized controlled trials of PPV and SB.
  
  
  METHODS
  A comprehensive literature search using the Cochrane Collaboration methodology to identify randomized controlled trials comparing PPV with SB for uncomplicated RRD.
  
  
  METHODS
  Analysis was divided into phakic and pseudophakic/aphakic patients. Primary outcome parameters included proportion of primary reattachment and difference of means of best-corrected visual acuity (BCVA) at 6 months or more between the PPV and SB groups. Secondary outcome parameters included the proportion of secondary reattachment and complications between the PPV and SB groups.
  
  
  RESULTS
  Seven studies were identified and analyzed for comparing PPV (636 eyes) with SB (670 eyes) for uncomplicated RRD. In the phakic group, there were no significant differences in the proportion of primary reattachments (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.69-1.46) or secondary reattachments (OR, 0.99; 95% CI, 0.34-2.87) between the PPV and SB groups. Meta-analysis showed a statistically significant difference in the logarithm of the minimum angle of resolution (logMAR) BCVA at 6 months between the PPV-treated and SB-treated phakic eyes (mean deviation, 0.14; 95% CI, 0.06-0.21; P<0.0004). In the pseudophakic/aphakic group, there were no significant differences in the proportion of primary reattachments (OR, 1.46; 95% CI, 0.79-2.71) or logMAR BCVA at 6 months between the PPV and SB groups (mean deviation, -0.03; 95% CI, -0.10 to 0.04). A statistically significant difference was noted in the proportion of secondary reattachments (OR, 2.08; 95% CI, 1.08-4.03; P = 0.03) between the PPV and SB groups in pseudophakic/aphakic eyes. Meta-analysis showed a statistically significant rate of cataract progression in the PPV group (OR, 4.11; 95% CI, 2.70-6.25; P<0.00001).
  
  
  CONCLUSIONS
  There were no significant differences in the proportions of primary reattachment in the PPV and SB groups in phakic eyes. The SB-treated phakic eyes had better postoperative BCVA at 6 months or more. This is most likely related to higher rates of cataract progression in PPV-treated phakic eyes. There were no significant differences in proportions of primary reattachment and postoperative BCVA at 6 months or more in pseudophakic/aphakic eyes.
authors.affiliation: Mason Eye Institute, Department of Ophthalmology, University of Missouri, Columbia, Missouri 65212, USA. SoniC@health.missouri.edu
authors.forename: Chetan
authors.initials: C
authors.lastname: Soni
authors.forename: Dean P
authors.initials: DP
authors.lastname: Hainsworth
authors.forename: Arghavan
authors.initials: A
authors.lastname: Almony
mesh_terms: D016208:Databases, Factual; D006801:Humans; D007431:Intraoperative Complications; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012163:Retinal Detachment / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012591:Scleral Buckling; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy