Title: Pars plana vitrectomy versus combined pars plana vitrectomy and scleral buckle for repair of primary rhegmatogenous retinal detachment with inferior retinal breaks.  

Purpose: To compare the anatomical and functional outcomes of pars plana vitrectomy (PPV) alone versus combined PPV and scleral buckle (SB) for the repair of rhegmatogenous retinal detachments (RRD) due to inferior retinal breaks.

Study design: Retrospective, nonrandomized, comparative single center study.

Methods: A retrospective chart review of patients who underwent combined PPV with SB or PPV alone for primary RRD with inferior retinal breaks, defined as breaks between 5 and 7 o’clock, performed between 2009 and 2019 by two surgeons at St. Michael’s Hospital, Toronto. The medical records of the patients were reviewed for preoperative RRD characteristics including baseline visual acuity (VA), lens status, extension of RRD, macular involvement. Patients with pre-existing proliferative vitreoretinopathy (PVR) were excluded. The primary outcomes were the single surgery anatomic re-attachment (SSAR) rate at one year, final anatomic re-attachment (FAR) rate at two years or more regardless of number of surgical repairs, and VA improvement in each group.

Results: A total of 141 patients were included, of which 86 had PPV alone while 55 had PPV/SB. There was no difference in the SSAR rate at one year between the PPV group (90.7%) and the PPV/SB group (92.7%), p=0.67. The FAR rate at 2 years was (100%) in both study groups. The PPV group had less pseudophakic patients [(32.6% PPV) vs (49.1% PPV/SB), p=0.05] and macula-off RRD patients [(60.5% PPV) vs (78.2% PPV/SB), p=0.02] compared to the PPV/SB group. However, there was no significant deference in the proportion of RRDs with >3 quadrants of detached retina between both groups (38% PPV) vs (49.1% PPV/SB), p=0.2. The PPV group had more patients who underwent intraoperative cryopexy (25.6%) compared to the PPV/SB group (1.8%), p=0.001. There were no significant differences in preoperative and 24 months postoperative vision (mean logMAR visual acuity +SD) between both groups [PPV(1.1 ±1.0) vs PPV/SB(1.2 ±0.9), (p=0.76)], and [PPV(0.5 ±0.7) vs PPV/SB(0.5 ±0.4), (p=0.78)], respectively.   

Conclusions: Primary PPV and PPV/SB for RRDs with inferior retinal breaks had similar SSAR, FAR and functional outcomes.

Pars plana vitrectomy versus combined pars plana vitrectomy and scleral buckle for repair of primary rhegmatogenous retinal detachment with inferior retinal breaks

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