SCLERAL BUCKLING versus PRIMARY VITRECTOMY in the MANAGEMENT of RETINAL DETACHMENT ASSOCIATED with MILD VITREOUS HEMORRHAGE

Background and Objective: The aim of the study is to compare the surgical impact on the anatomic results and visual recovery of scleral buckling (SB) and pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment with mild vitreous hemorrhage.
Patients and Methods: Included in the study were 78 eyes of 78 phakic patients undergoing primary surgery for rhegmatogenous retinal detachment complicated by mild vitreous hemorrhage (38 eyes by SB,40 eyes by PPV);all patients had been followed for longer than 6 months after surgery. The surgical outcome and the rate of complications were retrospectively compared. Mann-Whitney U-test and Chi-square test was used for the statistical analysis.
Results: The reattachment rate after the first surgery was 78.9%(30/38) in SB group and 95%(38/40) in PPV group.The difference between the groups was statistically significant (p=0.035). Unseen retinal breaks in 4 eyes, malpositioned buckle in 2 eyes and insufficent closure of the break in 2 eyes of SB cases,and reopening of original break in 2 eyes of PPV cases were the causes of the failure. Visual improvement in the PPV group was significantly better than in the SB group in the third and sixth postoperative months (p<0.001 and p=0.026 respectively). Peroperative and postoperative complications were as follows: subretinal hemorrhage (5.2%),PVR of grade B or worse (10.5%),macular pucker (7.8%) and postoperative cataract (13%) in the SB group, and iatrogenic breaks (10%), lens damage (5%), PVR of grade B or worse (5%),macular pucker (5%) and postoperative cataract (35%) in the PPV group.
Conclusions: Even though the high incidence of peroperative complications such as iatrogenic breaks or postoperative complications such as cataract formation was the major drawback, the results indicate that pars plana vitrectomy performed to alleviate peripheral vitreoretinal tractions and clear vitreous hemorrhage offers better anatomic and functional results than scleral buckling in rhegmatogenous retinal detachment associated with mild vitreous hemorrhage.