Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment

This study aimed to compare the results of primary vitrectomy and conventional scleral buckling procedures (conventional retinal detachment surgery) in phakic rhegmatogenous retinal detachment (RRD).

We carried out a randomized, prospective, clinical controlled trial of 61 consecutive phakic eyes with primary RRD, not complicated by proliferative vitreoretinopathy >or= grade C. Subjects were randomized to either scleral buckling (group 1) or pars plana vitrectomy (group 2).

At 6 months follow-up, the primary reattachment rate was 80% (24/30 cases) in group 2 and 80.6% (25/31 cases) in group 1; the difference between the two groups was not statistically significant (p = 0.213). Best corrected visual acuity improved significantly from a preoperative median of 1.78 (1/60) (mean 1.73 +/- 0.91, range 0.3-3) to a median of 0.6 (6/24) (mean 0.689 +/- 0.35, range 0.18-1.48) in group 2 and from a preoperative median of 1.48 (2/60) (mean 1.43 +/- 0.92, range 0-3) to a median of 0.6 (6/24) (mean 0.608 +/- 0.36, range 0-1.78) in group 1; the difference between the two groups was not statistically significant (p = 0.376). Cataract developed in five cases (17%) in the vitrectomy group (group 2), with a statistically significant difference of p = 0.018.

Although primary vitrectomy can achieve anatomical and functional success rates comparable with those achieved by scleral buckling in uncomplicated forms of phakic RRD, the major drawback of the procedure is the high incidence of postoperative cataract formation. Moreover, visual rehabilitation takes place earlier with scleral buckling than with vitrectomy. Scleral buckling should thus be used as the primary surgical modality in the treatment of uncomplicated RRD where the media are sufficiently clear.