[Conventional ablation surgery or primary vitrectomy in complicated retinal holes]

Area of Science:

• Ophthalmology
• Retinal Surgery

Background:

• Retinal detachment presents complex surgical challenges, particularly with difficult break configurations like multiple, large, or central holes.
• A retrospective analysis of 100 challenging cases from 803 consecutive retinal detachments was conducted.

Purpose of the Study:

• To determine the optimal surgical procedure for retinal detachment repair in eyes with complex break configurations.
• To compare the efficacy and complication profiles of conventional buckling surgery versus primary vitrectomy.

Main Methods:

• The study involved 100 eyes with retinal detachment and difficult break configurations.
• Eyes were treated with either conventional buckling surgery (encircling buckle plus sponge exoplant or multiple sponge exoplants; n=60) or primary vitrectomy (vitrectomy with intraocular gas, with or without an encircling band; n=40).

Main Results:

• Both encircling buckle/sponge exoplant and primary vitrectomy groups achieved high primary retinal attachment rates (98.3% and 92.5%, respectively).
• Redetachment rates were similar, occurring in 6.7% of the buckling group and 10% of the vitrectomy group during follow-up.
• Complication profiles differed: buckling surgery had risks of retinal incarceration and subretinal hemorrhage, while vitrectomy presented higher rates of iatrogenic holes and choroidal detachment, with a notable incidence of transiently increased intraocular pressure.

Conclusions:

• Primary retinal attachment rates are comparable between conventional buckling surgery and primary vitrectomy for complex retinal detachments.
• The choice of surgical procedure should consider the distinct spectrum of intraoperative and postoperative complications associated with each approach.