Pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone for patients with rhegmatogenous retinal detachment at high risk for proliferative vitreoretinopathy

Abstract

Purpose: To compare using pars plana vitrectomy (PPV) combined with a scleral buckle versus primary vitrectomy alone in patients with rhegmatogenous retinal detachment at high risk for postoperative proliferative vitreoretinopathy (PVR).

Methods: Six hundred and seventy-eight patients were identified from billing data as having rhegmatogenous retinal detachment between April 1, 2010 and August 1, 2012. Patients were considered at high risk for PVR if they presented with retinal detachment in 2 or more quadrants, retinal tears >1 clock hour, preoperative PVR, or vitreous hemorrhage.

Results: Of the 678 patients with rhegmatogenous retinal detachment, 65 were identified as high risk for PVR. Thirty-six patients were treated with simultaneous PPV-scleral buckle and 29 patients were treated with PPV alone, with an overall success rate of 63.1%. The use of PPV-scleral buckle was associated with significantly higher single surgery anatomical success compared with patients treated with PPV alone (odds ratio, 3.24; 95% confidence interval, 1.12-9.17; P = 0.029). Visual acuity at 3 months postprocedure or final follow-up was no different between the treatment groups. Overall, 23.1% of patients developed postoperative PVR with no difference between surgical approaches.

Conclusion: For patients at high risk for PVR, PPV-scleral buckle was associated with significantly higher rates of anatomical success compared with PPV alone.