Retinal Detachment Surgery

The Dilemma Between Personal Experience and Clinical Trials

Peter Walter

Disclosures

Expert Rev Ophthalmol. 2012;7(5):441-447. 

In This Article

More Controversy: Comparing the Three Principle Techniques

SB versus Primary Vitrectomy

Schaal et al. noted reattachment rates of 86% for SB, 90% for ppV alone, 94% for the combination of SB and ppV and 63% for PR after 1 year.[67]

For pseudophakic retinal detachments Le Rouic et al. found similar reattachment rates for SB as well as for ppV (84% SB vs 82.5% ppV)[68] confirmed by Miki et al. who found reattachment rates of 92% in both groups.[69]

The SPR trial was a large prospective randomized multicenter clinical trial comparing anatomical and functional outcome in patients with retinal detachments not suitable for a single 7.5-mm sponge using SB or primary vitrectomy. In phakic eyes, primary reattachment was achieved in 63.6% with SB and in 63.8 % with vitrectomy. Final anatomical success was also the same. However, final visual acuity was worse in the vitrectomy group because of cataract progression. In pseudophakic eyes, primary reattachment was achieved in 53.4% of eyes after SB but in 72.0% of eyes after vitrectomy. This difference was statistically significant. The final anatomic success again was the same; however, in the SB group more patients needed further intervention.[70]

In a smaller prospective randomized trial, Azad et al. did not find a statistically significant difference between SB and ppV with respect to retinal reattachment rates (80.6% for SB vs 80% for vitrectomy). Cataract progression in the vitrectomy group was the major risk factor for worse visual outcome, confirming the SPR findings.[71]

PR versus SB

The Retinal Detachment Study was a prospective clinical trial where SB was compared with PR in a multicenter setting. A total of 198 patients were followed over 6 months. Patients were recruited with retinal breaks not greater than 1 o'clock diameter and located in the superior two-third of the fundus. Significant PVR was excluded. The single operation reattachment rate was 82% for SB and 74% for PR. Final success rates were 98 and 99%, respectively. The occurrence of PVR was not significantly different between the groups but the morbidity was less in the PR group and the visual acuity was better in the PR group. Therefore, PR was recommended for those types of retinal detachments meeting the admission criteria.[72] The positive results were still seen after 2 years.[73]

Mulvihill et al. conducted a small prospective clinical trial comparing ten patients with PR and ten patients with SB. They reported a final success rate of 90% in the PR group and 100% in the SB group after one or more procedures.[74]

In the comparative case series of Han et al., single procedure success rates were reported for PR as 62% and for SB as 84%. In this series, 50 eyes in each group were followed for a minimum postoperative period of 6 months. However, the final reattachment rate was 98% in both groups. For phakic eyes the visual outcome was comparable in both groups.[75]

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