Combined vitrectomy, scleral buckling procedures result in fewer redetachments

April 15, 2008

Fewer retinal redetachments were reported following combined vitrectomy and scleral buckling procedures than with either procedure alone in a retrospective study. Factors such as the surgeon's skill and preoperative preparations also influence the outcome of retinal detachment surgery, however.

Key Points

Four surgeons performed the procedures in this series. Although some had a better success rate with vitrectomy, overall, the combined procedure had the lowest redetachment rate, according to Dr. Kieselbach.

In this retrospective study, Dr. Kieselbach, professor of ophthalmology, Medical University of Innsbruck, Austria, and colleagues evaluated the rate of redetachments in uncomplicated retinal detachment surgery in a consecutive series of 332 eyes with primary rhegmatogenous retinal detachment. The procedures included 20-gauge vitrectomy with laser coagulation and air (n = 139), episcleral buckle procedures with cryocoagulation (n = 146), and a combination of buckle and vitrectomy without cryocoagulation (n = 47). The observation period was 3.1 years, and the mean patient age was 62.5 years (range, 28 to 76 years).

The patient characteristics included no macular holes or no retinal breaks larger than 2 hours, no more than four breaks, no detachments older than 28 days, no proliferative vitreoretinopathy, a 33% rate of macular detachment, and redetachment occurring within 3 months of the initial procedure.

In their chart review, the investigators categorized the number and time of redetachments, type of intervention, and identification of possible failures.

Redetachment rates

The overall redetachment rate was 21%; 6% of patients required a third procedure. The redetachment rates for each of the four surgeons ranged from 19% to 48%.

The combination procedure had the lowest redetachment rate, 19% (p < 0.01), followed by scleral buckle and vitrectomy with added light, both 29%, and vitrectomy with lightpipe, 49%.

The study also revealed that unidentified holes, new holes at the entry site, and an unpredictable learning curve for different techniques were the most common reasons for redetachments, Dr. Kieselbach said.

Scleral buckling, for many years, was the standard treatment for retinal detachment, but vitrectomies have become more common, with the result that younger surgeons in some countries increasingly do not receive training in buckling techniques, he said. Also, even experienced surgeons must adapt to changing tools and techniques, which can influence their skill level when dealing with a particular patient, Dr. Kieselbach added.

An encircling band rather than a buckle was used in many of the cases in this study, he said, adding that the combination of vitrectomy and the band, which helps to clean the vitreous base and supports the equator, appears to be better than either procedure alone.