Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

Tae Hyuk Koh; Moon Jeong Choi; Sung Won Cho; Tae Gon Lee; Jae Heung Lee

doi:10.3341/jkos.2010.51.3.366

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Koh, Choi, Cho, Lee, and Lee: Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

Original Article

J Korean Ophthalmol Soc 2010;51(3):366-371.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.366

Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

Tae Hyuk Koh, MD¹, Moon Jeong Choi, MD^1,, Sung Won Cho, MD, PhD¹, Tae Gon Lee, MD², Jae Heung Lee, MD, PhD¹

¹Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Korea

²Department of Ophthalmology, Konyang University, College of Medicine, Daejeon, Korea

Address reprint requests to Moon Jeong Choi, MD Department of Ophthalmology, Konyang University, College of Medicine, Kim's Eye Hospital #156 Youngdeungpo-dong 4-ga, Youngdeungpo-gu, Seoul 150-034, Korea Tel: 02-2639-7777, Fax: 02-2633-3976, E-mail: moon17272@kimeye.com

Received 9 April 2009 Accepted 2 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the outcomes of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RD).

Methods

One hundred and fifteen Eyes undergoing SB or PPV for the treatment of simple rhegmatogenous RD were prospectively identified and followed up at least six months. Anatomic results, functional outcomes and complications were compared between eyes treated with SB and eyes treated with PPV.

Results

We detected no significant differences in overall success rates or final vision quality between the two treatment groups. However, the final vision quality of pseudophakic patients treated with PPV was significantly better than the final vision quality of pseudophakic patients treated with SB. Two treatment goups experienced similar rates of intraocular pressure elevation and proliferative vitreoretinopathy development. In phakic patients, the rates of cataract progression were higher in patients treated with PPV than in patients treated with SB.

Conclusions

PPV can be an effective method for the treatment of simple rhegmatogenous RD, and maybe considered as a viable alternative to SB for simple cases. However, in phakic patients treated with PPV, simultaneous or follow-up cataract surgery should be considered as adjuvant treatments.

Keywords: Retinal detachment, Scleral buckling, Vitrectomy

References

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Figure 1.

BCVA^§ change of macula off patients showed primary success. ^§ BCVA=best corrected visual acuity; ^* A=foveal reattached group after postoperative 1–2month by OCT (=optical coherence tomography); ^†B=foveal detached group after postoperative 1–2month by OCT.

Table 1.

Demographics and clinical datas of the patients

	Vitrectomy (N=55)	SB^† (N=60)	p
Age (years)	53.9±10.2	49.1±16.6	0.063
Sex (Male/Female)	27/28	32/28	0.711
Mean F/U period (months)	11.5±3.3	10.3±3.6	0.078
Phakic/pseudophakic	45/10	53/7	0.432
Preoperative BCVA^* (logMAR)	1.13±1.07	0.95±1.00	0.342

^* BCVA=best corrected visual acuity

^† SB=scleral buckling.

Table 2.

Clinical aspects of breaks and detachment

	No. of eyes (%)		p
	Vitrectomy(n=55)	Scleral buckling(n=60)	p
Large tear (>3DD^*)	17(30.9)	10(16.7)	0.082
Multiple tear	32(58.2)	42(70.0)	0.243
Macula off detachment	34(61.8)	38(63.3)	1.000

^* DD=disc diameter.

Table 3.

Primary operation procedure

Methods	No. of eyes (%)
	Vitrectomy	Scleral buckling
	(N=55)	(N=60)
With cataract operation	6/45(13.3)	1/53(1.9)
23G vitrectomy	15(27.3)	–
Tamponade
SF₆	7(12.7)	–
C₃ F₈	48(87.3)	–
Buckle material
506 sponge	–	59(98.3)
507 sponge	–	1(1.7)
External SRFD^*	–	6(10)
Retinotomy	9(16.4)	–

^* SRFD=subretinal fluid drainage.

Table 4.

Overall success rate

Success rate	Vitrectomy	Scleral buckling	p
Success rate	(N=55)	(N=60)	p
Primary	92.7%(51/55)	81.7%(49/60)	0.099
Final	98.2%(54/55)	96.7%(58/60)	1.000

Table 5.

Success rate according to lens status of vitrectomy and scleral buckling

	Vitrectomy	Scleral buckling	p
Phakic group
Primary success	91.1%(41/45)	84.9%(45/53)	0.538
Final success	97.8%(44/45)	100.0%(53/53)	0.459
Pseudophakic group
Primary success	100.0%(10/10)	57.1%(4/7)	0.051
Final success	100.0%(10/10)	71.4%(5/7)	0.154

Table 6.

Best corrected visual acuity and number of eyes showed visual acuity improvement more than 0.3

	BCVA^* (logMAR)		p	BCVA improvement, No. of eyes(%)		p
	Vitrectomy	SB^†	p	Vitrectomy	SB	p
Preoperative	1.14±1.06	1.02±1.00	0.516	–	–	–
Final	0.20±0.24	0.28±0.29	0.114	36(65.5)	35(58.3)	0.450

^* BCVA=best corrected visual acuity

^† SB=scleral buckling.

Table 7.

BCVA change in phakic group and pseudophakic group

	Vitrectomy (logMAR)	SB (logMAR)	p
	(mean± SD)	(mean± SD)
Phakic group
Preoperative BCVA^*	1.17±1.08	1.02±0.99	0.463
Final BCVA	0.22±0.24	0.27±0.28	0.322
Pseudophakic group
Preoperative BCVA	1.00±1.02	1.00±1.12	1.00
Final BCVA	0.14±0.22	0.56±0.14	0.042

^* BCVA=best corrected visual acuity.

Table 8.

Complication

	Vitrectomy	Scleral buckling	p
Cataract progression	58.2%(32/55)	8.3%(5/60)	0.001
PVR^*	5.5%(3/55)	11.7%(7/60)	0.326
IOP^† elevation	7.3%(4/55)	3.3%(2/69)	0.424

^* PVR=proliferative vitreoretinopathy

^† IOP=intraocular pressure.

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