• Retina/Vitreous

    Vitrectomy combined with scleral buckle achieved results superior to vitrectomy alone in the treatment of rhegmatogenous retinal detachment (RRD) with vitreous hemorrhage.

    Study design

    This was a retrospective cohort study that recruited patients from a single multi-surgeon institution. The purpose of the study was to compare the anatomic and functional outcomes of pars plana vitrectomy (PPV) alone versus combined vitrectomy and scleral buckle (PPV/SB) in the treatment of RRD with vitreous hemorrhage. The primary outcome was single-surgeon anatomic success (SSAS) at 6 months. Secondary outcome measures included mean visual acuity, postoperative PVR rate, and repeat PPV for non-RD reasons. The choice of procedure was at the surgeon’s discretion.

    Outcomes

    In this study, a total of 138 eyes underwent PPV versus 85 that had PPV/SB. Results demonstrated a superior SSAS with PPV/SB as compared with PPV alone, despite the fact that this cohort had higher rates of inferior pathology and preoperative PVR, more clock hours of detachment, and a larger proportion of phakic eyes. As a secondary outcome, the rates of documented PVR at 6 months were lower in the PPV/SB cohort despite higher baseline PVR rates. The number of surgeries required to achieve reattachment was higher in the PPV alone group than in the PPV/SB cohort.

    Limitations

    Limitations of this study include its retrospective nature as well as the variability of postoperative follow-up. In addition, the degree of vitreous hemorrhage was not detailed, leading to the potential for variable outcomes. Finally, the decision for the type of surgery was left to the surgeon’s discretion. A randomized study would eliminate this preoperative surgical selection bias.

    Clinical significance

    For surgeons, efficiency is important and scleral buckles add significant time and cost to surgery. This study demonstrates that spending the time and added cost on the initial surgery by placing a buckle in cases of RRD with vitreous hemorrhage will save time and money in the long term by avoiding the need for repeat surgeries.