Türk Oftalmoloji Dergisi (Mar 2014)

Scleral Buckling Versus Primary Vitrectomy in the Management of Retinal Detachment Associated with Mild Vitreous Hemorrhage

  • Tansu Erakgün,
  • Serhad Nalçacı,
  • Filiz Afrashi

DOI
https://doi.org/10.4274/tjo.18189
Journal volume & issue
Vol. 44, no. 2
pp. 92 – 97

Abstract

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Objectives: The aim of this study was to compare the surgical impact of scleral buckling (SB) and pars plana vitrectomy (PPV) on the anatomic results and visual recovery in cases of rhegmatogenous retinal detachment with mild vitreous hemorrhage. Materials and Methods: In this study, we included 78 eyes of 78 phakic patients who underwent primary surgery for rhegmatogenous retinal detachment complicated by mild vitreous hemorrhage (38 eyes by SB,40 eyes by PPV);all patients had been followed for longer than 6 months after surgery. The surgical outcome and the rate of complications were retrospectively compared. Mann-Whitney U-test and chi-square test were used for the statistical analysis. Results: The reattachment rate after the first surgery was 78.9% (30/38) in the SB group and 95% (38/40) in the PPV group. The difference between the groups was statistically significant (p=0.035). Unseen retinal breaks in 4 eyes, malpositioned buckle in 2 eyes and insufficient closure of the break in 2 eyes of SB cases, as well as reopening of the original break in 2 eyes of PPV cases were the causes of failure. Visual improvement in the PPV group was significantly better than in the SB group in the third and sixth postoperative months (p<0.001 and p=0.026, respectively). Peroperative and postoperative complications were as follows: in the SB group-subretinal hemorrhage (5.2%), PVR of grade B or worse (10.5%), macular pucker (7.8%), and postoperative cataract (13%); in the PPV groupiatrogenic breaks (10%), lens damage (5%), PVR of grade B or worse (5%),macular pucker (5%), and postoperative cataract (35%). Conclusion: Even though the high incidence of peroperative complications such as iatrogenic breaks or postoperative complications such as cataract formation was the major drawback, the results indicate that PPV performed to alleviate peripheral vitreoretinal tractions and clear vitreous hemorrhage offers better anatomic and functional results than SB in the management of rhegmatogenous retinal detachment associated with mild vitreous hemorrhage. (Turk J Ophthalmol 2014; 44: 92-7)

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