Morphological and functional outcome of scleral buckling surgery compared to primary vitrectomy in patients with retinal detachment

Miroslav Stamenković; Ivan Stefanović; Ivan Senćanić; Vesna Jakšić; Milka Mavija; Siniša Babović

doi:10.2298/3143

Miroslav Stamenković Eye Clinic, Clinical Center Zvezdara, Belgrade, Serbia
Ivan Stefanović Faculty of Medicine, University of Belgrade, Serbia
Ivan Senćanić Eye Clinic, Clinical Center Zvezdara, Belgrade, Serbia
Vesna Jakšić Eye Clinic, Clinical Center Zvezdara, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
Milka Mavija University Eye Clinic, Banjaluka, Republic of Srpska, Bosnia and Herzegovina
Siniša Babović Eye Clinic, Clinical Center Zvezdara, Belgrade, Serbia

DOI: https://doi.org/10.2298/3143

Keywords: retinal detachment, scleral buckling, vitrectomy, visual acuty, treatment outcome,

Abstract

Background/Aim. Among the proposed operative techniques for retinal detachment (RD) the most commonly applied are classical method with scleral buckling and pars plana vitrectomy (PPV). The aim of this paper was to determine which surgical intervention of these two leads to better morphological results in terms of the applied retina and better functional outcomes in terms of visual acuity (VA) of the operated eye in patients with RD. Methods. A retrospective study on the comparative section of the effects of scleral buckling surgery and PPV in uncomplicated rhegmatogenous RD was performed. In a 2-year period 97 patients, i.e. 98 eyes with RD were operated on (68 eyes with scleral buckling surgery vs 30 by PPV). Results. In the group with classically operated detachment, the retina was applied in 52 (76.5%) cases vs 30 (100%) patients in PPV group (p < 0.05). Postoperative VA in logMAR was significantly better in both groups compared to preoperative VA: in the classically operated was 1.89 ± 1.04 preoperatively vs 0.98 ± 0.70 postoperatively, while in the PPV group, preoperative value was 2.56 ± 0.67 vs 1.31 ± 0.74 postoperatively (p = 0.001). Conclusion. PPV in uncomplicated forms of RD gives better anatomical results than scleral buckling surgery. VA was significantly improved in both observed groups, while its mean value was postoperatively better in the group that was operated with the classical method. The reason for this could be due to better VA in baseline in the scleral buckling surgery group.

References

Birgul T, Vidic B, El-Shabrawi Y. Intrusion of an encircling buckle after retinal detachment surgery. Am J Ophthalmol 2003; 136(5): 942−4.

Kumar N, Zeldovich A, Chang A. Scleral buckle intrusion. Clin Experiment Ophthalmol 2004; 32(2): 228−9.

Kawana K, Okamoto F, Hiraoka T, Oshika T. Ciliary body edema after sclera buckling surgery in rhegmatogenous retinal de-tachment. Ophthalmology 2006; 113(1): 36−41.

OshimaY, Yamanishi S, Sawa M, Motokura M, Harino S, Emil K. Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal de-tachment. Jpn J Ophthalmol 2000; 44(5): 538−49.

Miki D, Hida T, Hotta K, Shinoda K, Hirakata A. Comparisson of sclera buckling and viterctomy for retinal detachment re-sulting from flap tears in superior quadrants. Jpn J Ophthalmol 2001; 45(2): 187−91.

Heimann H, Zou X, Jandeck C, Kellner U, Bechrakis NE, Kreusel KM, et al. Primary vitrectomy for rhegmatogenous retinal de-tachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol 2006; 244(1): 69−78.

Sharma YR, Karunanithi S, Azad RV, Vohra R, Pal N, Singh V, et al. Functional and anatomic outcome of sclera buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand 2005; 83(3): 293−7.

Tewari HK, Kedar S, Kumar A, Garg SP, Verma LK. Comparison of sceral buckling with combined sclera buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks. Clin Experiment Ophthalmol 2003; 31(5): 403–7.

Lincoff H, Kreissing I. Ectraocular repeat surgery of retinal de-tachment. A minimal approach. Ophthalmology 1996; 103(10): 1586−92.

Thompson JT. The effects and action of scleral buckles in treat-ment of retinal detachment. In: Ryan SJ, editor. Retina. 4ed. St. Louis: Mosby; 2006. p. 2021−34.

Lee EJ. Use of nitrous oxide causing severe visual loss 37 days after retinal surgery. Br J Anaesth 2004; 93(3): 464−6.

Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 2007: 114(2): 2142−54.

Martinez-Castillo V, Verdugo A, Boixadera A, García-Arumí J, Corcóstegui B. Menagement of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol 2005; 123(8): 1078−81.

Lois N, Wong D. Pseudophakic retinal detachment. Surv Oph-thalmol 2003; 48(5): 467–87.

Rodriguez de la Rúa E, Pastor JC, Aragón J, Mayo-Iscar A, Martínez V, García-Arumí J, et al. Interaction between surgical procedure for repairing retinal detachment and clinical risk factors for proliferative vitreoretinopathy. Curr Eye Res 2005; 30(2): 147−53.

Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers R, Foerster MH. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment. A prospective rando-mized multicenter clinical study. Ophthalmology 2007; 114(12): 2142−54.

Heimann H, Bornfeld N, Bartz-Schmidt UK, Hilgers RD, Heussen N. Anaylsis of the surgeon factor in the treatment results of rhegmatogenous retinal detachment in the scleral buckling ver-sus primary vitrectomy in rhegmatogenous retinal detachment study. Klin Monbl Augenheilkd 2009; 226(12): 991−8. (Ger-man)

Oshima Y, Emi K, Motokura M, Yamanishi S. Surgical indications and results of primary pars plana vitrectomy for rhegmatogen-ous retinal detachment. Nihon Ganka Gakkai Zasshi 1998; 102(6): 389−94. (Japanese)

Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand 2007; 85(5): 540−5.