Comparison of pars plana vitrectomy and scleral buckling for uncomplicated rhegmatogenous retinal detachment

Retinal detachment surgery can now achieve a final reattachment rate in over 90% of cases. The operation of choice in most cases is that of external scleral buckling with or without drainage of subretinal fluid. However, in a minority of cases these techniques are difficult to apply either when the breaks are unseen due to media opacities or when the breaks are complex, eg, posterior, large, or multiple breaks at different distances from the ora. Improvements in the technique of pars plana vitrectomy for retinal detachment now offers us an alternative method for treating these difficult cases. Pars plana vitrectomy for retinal detachments with unseen or complex breaks has a final attachment rate of over 90%, is technically easier to perform than conventional surgery, and avoids the refractive and ocular motility problems associated with complicated buckles. For these reasons and despite the high risk of nuclear sclerosis in phakic eyes, a pars plana vitrectomy may be the preferred option in selected cases of primary retinal detachment.