Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1.


Acar Gocgıl N.

Ophthalmology, cilt.120, ss.1804-1808, 2013 (SCI İndekslerine Giren Dergi)

  • Cilt numarası: 120 Konu: 9
  • Basım Tarihi: 2013
  • Dergi Adı: Ophthalmology
  • Sayfa Sayıları: ss.1804-1808

Özet

OBJECTIVE:

To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs).

DESIGN:

Nonrandomized, multicenter retrospective study.

PARTICIPANTS:

One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs.

METHODS:

Reported data included specific clinical findings, the method of repair, and the outcome after intervention.

MAIN OUTCOME MEASURES:

Final 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 detachment (level 3 failure rate).

RESULTS:

Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10(-8)). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034).

CONCLUSIONS:

In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful.