Regional EuroTimes
Date Posted 17/05/2009
Better outcomes with buckling and vitrectomy than with vitrectomy alone
Retinal detachment patients with proliferative vitreoretinopathy who undergo vitrectomy alone are at a higher risk of retinal detachment recurrence than are those who undergo vitrectomy combined with sclera buckling, according to the results of a study presented at the 9th EURETINA Congress by Ahmed Shoeir MD, Research Institute of Ophthalmology, Cairo, Egypt.
“There is a controversy about sclera buckling with pars plana vitrectomy. The success rate of pars plana vitrectomy plus silicone oil injection and sclera buckling has reached up to 90 % which is very acceptable. But many studies suggest the same results can be achieved with vitrectomy asnd silicone oil alone,” Dr Shoeir said.
The study involved 40 consecutive eyes with rhegmatogenous retinal detachment with PVR grade C were offered either vitrectomy & silicon oil injection in combination with encircling scleral buckling procedure or vitrectomy & silicon oil injection alone. Main outcome measures were reattachment with a single surgery, visual acuity (VA), and detachment after silicon removal over the study period.
Retina reattachment with a single surgery was achieved in 85% in the eyes which underwent scleral buckling and vitrectomy and in 80% of the eyes which underwent vitrectomy alone. Improvements of logMAR visual acuity of 0.1 or more was achieved in 17 eyes (85 %) in the vitrectomy plus scleral buckling group and in 14 eyes (70 %) in the vitrectomy alone group.
The rate of retinal detachment recurrence was 15 % in the buckle and vitrectomy group after a follow-up of 11.94 months (range: in to 20 months). That compared to a retinal detachment recurrence rate of 30% in the vitrectomy alone group after a follow-up of 10.86 months (range: eight to 14 months).
“The potential advantages of vitrectomy include minimal trauma to the eye reduced pain and postoperative swelling minimal change of refractive error and reduced surgical time. However recurrent retinal detachment was significantly higher in patients who underwent vitrectomy alone especially in cases with type 4 PVR. The buckle induced refractive changes are not of great importance because refraction can be corrected during cataract surgery,” Dr Shoeir added.
There were no buckle related complications except mild oedema retinal detachment after silicone oil occurred in three cases in the buckle plus vitrectomy group and four cases in the
inalPatients who undergo vPurpose: To determine if scleral explants are required to svitrectomy alone group. upport retinal periphery and vitreous base following PPV for retinal detachment complicated with proliferative vitreoretinopathy (PVR) grade C.
) in group B. Recurrence after silicon removal in grade C PVR type 4& 5 was higher in group A as compared to group B (2 of 7) eyes (28.6%) and (5 of 8) eyes (62.5%)SETTING:
METHODS: All Preoperative and postoperative patient characteristics were recorded in detail. RESULTS: CONCLUSIONS: Scleral buckle decreases the incidence of recurrent retinal detachment when combined with vitrectomy in cases with rhegmatogenous retinal detachment complicated with PVR specially when circumferential contraction and retinal shortening is detected. Financial Disclosure: No
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