Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2
Abstrakt
To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n =
917), (2) grade C-1 PVR (n =
637), (3) choroidal detachment or significant hypotony (n =
578), (4) large or giant retinal tears (n =
1167), and (5) macular holes (n =
153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P =
0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P =
0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P =
0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P =
0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7x10(-8)). In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful.