Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2-main results.
It is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy.



257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months.



Success was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average -0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of -1.0 D in group E1 compared with -0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1.



Vitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique.



DKRS 00003158, Results.
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Peter
P
Walter
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
Martin
M
Hellmich
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Sabine
S
Baumgarten
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
Petra
P
Schiller
Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany.
Endrik
E
Limburg
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Hansjürgen
H
Agostini
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.|Eye Hospital, Hannover Medical School, Hannover, Germany.
Amelie
A
Pielen
Department of Ophthalmology, University of Regensburg, Regensburg, Germany.
Horst
H
Helbig
Department of Ophthalmology, Franziskus Hospital, Münster, Germany.
Albrecht
A
Lommatzsch
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Gernot
G
Rössler
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Babac
B
Mazinani
D000368:Aged; D058450:Endotamponade / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019591:Pseudophakia / Q000503:physiopathology / Q000601:surgery*; D012163:Retinal Detachment / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
Retina; Treatment Surgery