Surgical Outcome of Scleral Buckling Versus Pars Plana Vitrectomy In Primary Pseudophakic Rhegmatogenous Retinal Detachment

Abstract

Objective: To evaluate anatomical and visual outcome of scleral buckling surgery versus pars
plana vitrectomy in pseudophakic patients with rhegmatogenous retinal detachment.
Material and Methods: Sixty patients having rhegmatogenous retinal detachment , fulfilling
inclusion and exclusion criteria were recruited for study. The patients were divided randomly in
two groups of thirty patients each. In group (A) 30 patients underwent conventional scleral
buckling and in group (B), 30 patients with retinal detachment had pars plana vitrectomy done.
Almost all patients were having macula off, with history of decreased visual acuity ranging
between one week to eight weeks. The patients with grade C proliferative vitreo-retinopathy
(PVR), previous scleral buckling / vitrectomy, posterior vitreous detachment and pseudophakic
with posterior capsular rupture were also excluded. After detailed preoperative assessment and
surgical plan, standard scleral buckling procedure including encircling and local explants with
cryo-therapy, was used to repair all primary rhegmatogenous detachments in group A. Sub-retinal
fluid (SRF) drainage was performed, as needed. In group B, 20G pars plana vitrectomy was
performed in all pseudophakic retinal detachments. All the per-operative and postoperative
complications were recorded. The outcome measures of study were visual outcome and
anatomical status of retina, after retinal re-attachment surgery. The patients were followed at least
six months after surgery regarding, visual acuity, intra-ocular pressure, retinal re-attachment.
Results: Thirty eyes in group A were treated by scleral buckling and cryotherapy, while 30 eyes
in group B were managed by primary pars plana vitrectomy. All retinal detachments were macula
off, with grade A or B, PVR. Anatomical success rate in Scleral buckling group was 86.66 % and
13.33 % patients had re-detachment, so pars plana vitrectomy was performed. One patient was
managed with intra-vitreal SF6 gas injection and 360 degree laser barrage. Anatomical success
rate in pars plana vitrectomy group was 90 %, while 10 % patients were managed by second
surgery. No significant complication was noted in both types of surgeries.
Conclusion: Pseudophakic rhegmatogenous retinal detachments, can be managed effectively
by pars plana vitrectomy and scleral buckling, with comparable visual and anatomical outcome