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Paper Information

Journal:   BINA   Fall 2003 , Volume 9 , Number 1 (33); Page(s) 14 To 25.
 
Paper: 

PRIMARY VITRECTOMY VS SCLERAL BUCKLING IN MANAGEMENT OF RETINAL DETACHMENT IN PATIENTS WITH HISTORY OF CATARACT EXTRACTION

 
 
Author(s):  AHMADIEH H., MORADIAN SIAMAK, FAGHIHI H., PARVARESH M., GHANBARI H., MEHRIAR M., HEIDARI E., BEHBOUDI H., BANAEI T., ENTEZARI MORTEZA, SOURI H., GOLESTAN B., RABANIKHAH Z., ANISIAN A.
 
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Abstract: 

Purpose: To compare the visual and anatomical outcomes and complications of primary vitrectomy versus scleral buckling in the management of retinal detachment in patients with history of cataract extraction.

Methods: In this multicenter randomized controlled trial, all patients with retinal detachment after cataract surgery were enrolled and randomly assigned to two treatment groups: conventional scleral buckling and standard 3-port pars plana deep vitrectomy. They had follow up visits at 1, 2, 4, and 6 months postoperatively and visual acuity, anatomical status of the retina, and postoperative complications were evaluated and compared.

Results: Of 225 eligible eyes, 126 underwent scleral buckling and 99 had deep vitrectomy.

Statistically significant different characteristics between the 2 groups included: age, preoperative

visual acuity, family history of retinal detachment, vitreous incarceration in cataract wound, history of secondary IOL implantation, history of retinal detachment in the sound eye, and extent of retinal detachment. Time interval between initiation of RD symptoms to RD surgery in the buckle group and vitrectomy group were 20.8 and 22.2 days, respectively. Retinal break detection during surgery in the buckle group and vitrectomy group were 27.1% and 33.5%, respectively. BCVA (log MAR) 6 months after operation in the buckle group and vitrectomy group were 0.96±0.68 and 0.96±0.62, respectively. Anatomical success rate at 6 months postoperatively in eyes with vitreous incarceration in cataract wound was 58.3% and 68.4% in the buckle group and vitrectomy group, respectively and in eyes without that was 78% in buckle group and 74.5% in vitrectomy group, which did not have any statistically significant difference. Six months postoperatively, retinal redetachment rate in the buckle group was 32% and in vitrectomy group was 37.2%. CME rate in buckle group was 6.6% and in vitrectomy group was 9.1%. Macular pucker in buckle group and vitrectomy group were 22% and 22.7%, respectively. IOP>20 mmHg in buckle group was 6.4% and in vitrectomy group was 5.7%. None of the above mentioned characteristics had statistically significant difference. Extraocular muscle dysfunction was the only complication that was significantly different between the 2 groups; 4.1% in buckle group and zero in vitrectomy group.

Conclusion: Primary vitrectomy does not seem to be a more reasonable option than scleral buckling in the management of eyes with history of cataract surgery. Therefore selection of these surgical options depends on judgment and experience of the surgeon, feasible facilities, and patient’s situation.

 

 

 
Keyword(s): PRIMARY VITRECTOMY, SCLERAL BUCKLING, RETINAL DETACHMENT, CATARACT EXTRACTION
 
References: 
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