ABSTRACT
Objective: to evaluate anatomical and visual outcome of scleral buckling surgery versus pars plana vitrectomy in pseudophakic patients with rhegmatogenous retinal detachment
Material and Methods: sixty patients having rhegmatogenous retinal detachment, fulfilling inclusion and exclusion criteria were recruited for study. The patients were divided randomly in two groups of thirty patients each. In group [A] 30 patients underwent conventional scleral buckling and in group [B], 30 patients with retinal detachment had pars plana vitrectomy done. Almost all patients were having macula off, with history of decreased visual acuity ranging between one week to eight weeks. The patients with grade C proliferative vitreo-retinopathy [PVR], previous scleral buckling / vitrectomy, posterior vitreous detachment and pseudophakic with posterior capsular rupture were also excluded. After detailed preoperative assessment and surgical plan, standard scleral buckling procedure including encircling and local explants with cryo-therapy, was used to repair all primary rhegmatogenous detachments in group A. Sub-retinal fluid [SRF] drainage was performed, as needed. In group B, 20G pars plana vitrectomy was performed in all pseudophakic retinal detachments. All the per-operative and postoperative complications were recorded. The outcome measures of study were visual outcome and anatomical status of retina, after retinal re-attachment surgery. The patients were followed at least six months after surgery regarding, visual acuity, intra-ocular pressure, retinal re-attachment
Results: thirty eyes in group A were treated by scleral buckling and cryotherapy, while 30 eyes in group B were managed by primary pars plan a vitrectomy. All retinal detachments were macula off, with grade A or B, PVR. Anatomical success rate in Scleral buckling group was 86.66 % and 13.33 % patients had re-detachment, so pars plana vitrectomy was performed. One patient was managed with intra-vitreal SF6 gas injection and 360 degree laser barrage. Anatomical success rate in pars plana vitrectomy group was 90 %, while 10 % patients were managed by second surgery. No significant complication was noted in both types of surgeries
Conclusion: pseudophakic rhegmatogenous retinal detachments can be managed effectively by pars plana vitrectomy and scleral buckling, with comparable visual and anatomical outcome