title: Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2.
abstract: OBJECTIVE
  To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs).
  
  
  METHODS
  Nonrandomized, multicenter, retrospective study.
  
  
  METHODS
  One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs.
  
  
  METHODS
  Reported data included clinical manifestations, the method of repair, and the outcome.
  
  
  METHODS
  Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate).
  
  
  RESULTS
  The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)).
  
  
  CONCLUSIONS
  In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA. ron.adelman@yale.edu.
authors.forename: Ron A
authors.initials: RA
authors.lastname: Adelman
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Parnes
authors.forename: Jack O
authors.initials: JO
authors.lastname: Sipperley
authors.forename: Didier
authors.initials: D
authors.lastname: Ducournau
mesh_terms: D015862:Choroid Diseases / Q000150:complications / Q000601:surgery*; D058450:Endotamponade / Q000379:methods*; D005060:Europe; D005466:Fluorocarbons / Q000008:administration & dosage; D019538:Health Care Surveys; D006801:Humans; D009885:Ophthalmology; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery*; D012167:Retinal Perforations / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012591:Scleral Buckling / Q000379:methods*; D012827:Silicone Oils / Q000008:administration & dosage; D012955:Societies, Medical; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*; D018630:Vitreoretinopathy, Proliferative / Q000150:complications / Q000601:surgery*
chemical_list: D005466:Fluorocarbons; D012827:Silicone Oils