Treatment of primary rhegmatogenous retinal detachment – scleral buckling or vitrectomy?

Background: Different surgical procedures are performed in the management of primary rhegmatogenous retinal detachment (RRD) based on its complexity. Aim: To compare the functional and anatomical results of scleral buckling (SB) and 23-gauge pars plana vitrectomy (PPV) in management of primary RRD. Methods: Retrospective study of 41 phakic eyes with primary RRD treated in 1-yearperiod, with minimum 6 months follow up, 21 treated with SB and 20 with PPV. In the SB procedure, all retinal breaks were localized, cryotherapy was done, and segmental scleral buckle was placed. Drainage of subretinal fluid was performed. In the standard 23-g PPV procedure, after cauterization of all retinal breaks, endolaser photocoagulation and tamponade with gas or silicone oil was done. Improvement in best corrected visual acuity (BCVA), anatomical success, number of reoperations, cataract progression and macular complications were compared. Results: In 21 eyes in SB group, the mean baseline BCVA was 0.28±0.31, the final BCVA was 0.66±0.28. 2 eyes (9.5%) needed re-surgery (PPV). In 20 eyes in PPV group, the mean baseline BCVA was 0.11±0.16, the final BCVA was 0.34±0.25. 3 eyes (15%) needed re-surgery. Both SB and PPV resulted in clinically significant improvement of BCVA, better in SB group (0.38 vs. 0.23 in PPV group). The anatomical success was high in both groups, better in the SB group (91.5% in SB vs. 85% in PPV). Permanent macular changes were more frequent in PPV group (25% in PPV vs. 14% in SB group). Cataract progression was significantly higher in PPV group (6 eyes (30%) vs. 3 eyes (14.2%) in SB group). Conclusion: Both procedures still have significant roles in treatment of RRD. SB is recommended as primary procedure in younger patients with RRD in one quadrant, to reduce early cataract surgery and possible chronic macular complications. PPV, especially phaco-vitrectomy, is probably a better option in older patients, with detachment in 2 or more quadrants and longer duration of the RRD