PARS PLANA VITRECTOMY AND SCLERAL BUCKLE VERSUS PARS PLANA VITRECTOMY ALONE FOR PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT AT HIGH RISK FOR PROLIFERATIVE VITREORETINOPATHY PHILIP STOREY, MD, MPH,* RAYAN ALSHAREEF, MD,* MOHAMMED KHUTHAILA, MD,* NIKOLAS LONDON, MD,* BENJAMIN LEIBY, PHD,† CHAR DECROOS, MD,* RICHARD KAISER, MD*; FOR THE WILLS PVR STUDY GROUP Purpose: To compare using pars plana vitrectomy (PPV) combined with a scleral buckle versus primary vitrectomy alone in patients with rhegmatogenous retinal detachment at high risk for postoperative proliferative vitreoretinopathy (PVR). Methods: Six hundred and seventy-eight patients were identified from billing data as having rhegmatogenous retinal detachment between April 1, 2010 and August 1, 2012. Patients were considered at high risk for PVR if they presented with retinal detachment in 2 or more quadrants, retinal tears .1 clock hour, preoperative PVR, or vitreous hemorrhage. Results: Of the 678 patients with rhegmatogenous retinal detachment, 65 were identified as high risk for PVR. Thirty-six patients were treated with simultaneous PPV–scleral buckle and 29 patients were treated with PPV alone, with an overall success rate of 63.1%. The use of PPV–scleral buckle was associated with significantly higher single surgery anatomical success compared with patients treated with PPV alone (odds ratio, 3.24; 95% confidence interval, 1.12–9.17; P = 0.029). Visual acuity at 3 months postprocedure or final follow-up was no different between the treatment groups. Overall, 23.1% of patients developed postoperative PVR with no difference between surgical approaches. Conclusion: For patients at high risk for PVR, PPV–scleral buckle was associated with significantly higher rates of anatomical success compared with PPV alone. RETINA 34:1945–1951, 2014

R

hegmatogenous retinal detachment (RRD) can be surgically treated with scleral buckling (SB), pars plana vitrectomy (PPV), or a combination of the two procedures. The most common cause of failure of surgical repair in RRD is proliferative vitreoretinopathy (PVR).1,2 The pathophysiology of PVR is complex and involves cellular proliferation, migration, and inflammation.3,4 A

number of studies have identified several patient characteristics associated with the development of postoperative PVR: retinal detachment (RD) in 2 or more quadrants,5–7 retinal tears .1 clock hour,5,6 preoperative PVR,5–8 and vitreous hemorrhage.5,6 In recent years, a number of randomized controlled trials (RCTs) and retrospective reviews have evaluated SB with or without PPV versus PPV alone for patients with RRD.9–17 However, the majority of clinical trials and reviews have focused on simple to moderately complex cases and no studies have specifically evaluated surgical repair in patients at high risk for PVR.9,10,12–18 This study aims to evaluate the optimal surgical procedure to reattach the retina for eyes with

From the *Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania; and †Division of Biostatistics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. None of the authors have any financial/conflicting interests to disclose. Reprint requests: Richard Kaiser, MD, Mid Atlantic Retina, Wills Eye Hospital, 840 Walnut Street, Suite 1020, Philadelphia, PA 19103; e-mail: [email protected]

1945

1946 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES

these high-risk features associated with the development of postoperative PVR.



2014  VOLUME 34  NUMBER 10

+2.0 logMAR based on previously published methods.19 All analysis was performed using STATA version 13 (StataCorp, College Station, TX).

Patients and Methods Results

Inclusion and Exclusion Criteria Institutional review board approval was obtained for this retrospective review. Billing data were used to identify the 678 patients with RRD treated with a combination of PPV and SB or PPV alone between April 1, 2010 and August 1, 2012 at one large retina practice. Published literature was reviewed to determine patient characteristics commonly associated with the development of postoperative PVR. Patients were deemed at high risk for PVR and were included in the study if they had an RD in 2 or more quadrants, retinal tears .1 clock hour, preoperative PVR Grade B–C, or a vitreous hemorrhage. Vitreous hemorrhage was considered present if blood obscured at least 5 clock hours of central or peripheral retina or if a large hemorrhage was located posterior to the equator. Patients were excluded if they had ,3 months of follow-up, were treated with SB without PPV, or were previously treated with an SB or vitrectomy in the study eye. Surgical Technique Patients undergoing a vitrectomy received a standard 3-port 23-gauge PPV using a noncontact wide-angle viewing system (Binocular Indirect Ophthalmomicroscope; Oculus, Wetzlar, Germany). Endolaser photocoagulation was applied either around the retinal tear or 360° to the vitreous base. In all cases, patients received nonexpansile perfluoro-n-octane (C3F8) in air (12–16%), sulfur hexafluoride (SF6) in air (20– 26%), or silicone oil (1,000 or 5,000-centistokes) for tamponade. Patients in the SB group received a 360° encircling band (2.5–4.0 mm in width) sutured to the sclera using 5-0 nylon suture and secured with a Watzke sleeve. Data Analysis Data were collected for analysis by chart review. Fisher exact test was used for categorical data, and the Mann–Whitney U-test was used for continuous data to compare demographic and clinical data between the two treatment groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to compare anatomical success rates. Multiple regression analysis was also performed. The Snellen visual acuity was converted to logarithm of the minimum angle of resolution (logMAR) values. The logMAR values for visual acuity of hand movements and counting fingers were assigned +3.0 logMAR and

Of the 678 patients reviewed, 65 (9.6%) met the aforementioned criteria and were included in the study. A group of 13 surgeons performed PPV–SB on 36 patients and PPV alone on 29 patients. Patient Characteristics Baseline demographics, including mean age, gender, lens status, baseline visual acuity, duration of follow-up, RD in .2 quadrants, total RD, tears .1 clock hour, primary PVR, vitreous hemorrhage, and macular detachment, did not differ between the PPV–SB and PPV-alone groups (Table 1). The use of long-acting intraocular gas (SF6 or C3F8) versus silicone oil as internal tamponade also did not differ between the treatment groups (Table 1). Anatomical Results The main outcome measure for this study was single surgery anatomical success (SSAS), which was defined as 1 operation to anatomically reattach 100% of the retina for a minimum of 3 months duration or until the end of the documented patient follow-up. The overall SSAS rate regardless of the surgical procedure for the 65 high-risk patients was 63.1%. For patients treated with PPV–SB, SSAS was 75.0% (27/36) compared with 48.3% (14/29) for patients treated with PPV alone. The use of PPV–SB was associated with significantly higher rates of SSAS compared with PPV alone, with an OR of 3.24 (95% CI, 1.12–9.17; P = 0.029) (Table 2). Nine of the patients who underwent PPV–SB surgery re-detached: six patients experienced a new retinal tear associated with PVR, two patients developed new retinal breaks unassociated with PVR, and one patient experienced reopening of previously identified retinal break. Fifteen patients undergoing PPV alone re-detached: nine patients experienced a new retinal tear associated with PVR, five patients experienced reopening of existing retinal breaks, and one patient developed new retinal breaks. Subset analysis revealed that patient age had an effect on anatomical outcomes of the surgical procedures. For the 39 patients aged 65 years and younger, PPV–SB had significantly higher success rates compared with PPV alone (84.6% for PPV–SB vs. 46.2% for PPV), with an OR of 6.42 (95% CI, 1.40–29.5; P = 0.017). For the 26 patients older than 65 years, there

1947

PPV–SB VERSUS PPV IN PATIENTS AT HIGH RISK FOR PVR  STOREY ET AL Table 1. Characteristics of Study Patients

Mean age ± SD (range), years Male, n (%) Lens status, n (%) Phakic IOL Aphakic Baseline visual acuity, logMAR Mean duration of follow-up (range), months RD in .2 quadrants, n (%) Total RD, n (%) Tears .1 clock hour, n (%) Primary PVR, n (%) Grade B Grade C Vitreous hemorrhage, n (%) Macula detached, n (%) Sulfur hexafluoride or perfluoropropane intraocular gas, n (%) Silicone oil, n (%)

PPV–SB (n = 36)

PPV (n = 29)

P (Method)

59.6 ± 13.2 (19.6–86.5) 24 (66.7)

65.3 ± 12.7 (41.2–90.0) 17 (58.6)

0.11 (MW) 0.61 (F)

15 (41.7) 20 (55.6) 1 (2.8) 1.19 ± 0.72 5.8 (3.1–18.6) 12 (33.3) 4 (11.1) 4 (11.1)

6 (20.7) 22 (75.9) 1 (3.4) 1.29 ± 0.78 6.2 (3.0–12.9) 9 (31.0) 5 (17.2) 5 (17.2)

2 (5.6) 12 (33.3) 6 (16.7) 25 (69.4) 29 (80.6)

1 (3.4) 6 (20.7) 6 (20.7) 20 (69.0) 20 (69.0)

0.75 (F) 1.0 (F) 0.39 (F)

7 (19.4)

9 (31.0)

0.39 (F)

0.12 (F) 0.44 0.52 1.0 0.50 0.50

(MW) (MW) (F) (F) (F)

0.49 (F)

F, Fisher exact test; IOL, anterior chamber intraocular lens; MW, Mann–Whitney U-test.

was no difference in anatomical outcomes between the surgical approaches (50.0% for PPV–SB vs. 50.0% for PPV; P = 1.0). Subset analysis of lens status revealed no statistically significant difference in outcomes between the treatment groups. In phakic patients, there was a nonsignificant trend toward PPV–SB having superior surgical success compared with PPV alone (66.7% PPV–SB vs. 33.3% PPV; OR, 4.00; 95% CI, 0.54–29.8; P = 0.18). In pseudophakic patients, there was also a nonsignificant trend toward PPV– SB having superior surgical success compared with PPV alone (80.0% PPV–SB vs. 54.5% PPV; OR, 3.33; 95% CI, 0.84–13.3; P = 0.087). Overall, lens status was not independently associated with SSAS (57.1% for phakic patients vs. 66.7% for pseudophakic patients vs. 50.0% for aphakic patients; P = 0.71). The effect of long-acting intraocular gas (SF6 or C3F8) versus silicone oil tamponade was also evaluated and was not found to significantly affect surgical outcomes. Overall, SSAS rates were 31 of 49 patients (63.3%) treated with intraocular gas compared with 10 of 16 patients (62.5%) treated with silicone oil (P = 1.0).

Univariable analysis of baseline factors (RD in .2 quadrants, total RD, retinal tears .1 clock hour, preoperative PVR, and vitreous hemorrhage) and treatment outcomes was performed. Within each individual risk group, there was no significant difference in SSAS between patients treated with PPV–SB versus PPV alone (data not shown). Multivariable analysis accounting for baseline factors (RD in .2 quadrants, total RD, retinal tears .1 clock hour, preoperative PVR, and vitreous hemorrhage) and interventions (silicone oil, gas, PPV–SB, and PPV) was also performed and found no variable to be significantly associated with anatomical success (data not shown). Secondary Outcomes Postprocedure best-corrected visual acuity (BCVA) and development of PVR were secondary outcomes of this study. At 3 months postsurgery and at final followup, there was no significant difference in BCVA between patients treated with PPV–SB versus PPV alone (3 months: 1.09 logMAR PPV–SB vs. 1.13 logMAR PPV, P = 0.79; final follow-up: 1.00 logMAR PPV– SB vs. 1.01 logMAR PPV, P = 0.90) (Table 2). Overall,

Table 2. SSAS Rates, BCVA, and Development of PVR

SSAS, n (%) Mean BCVA 3 months postprocedure, logMAR Mean BCVA at final follow-up, logMAR Development of PVR, n (%)

PPV–SB (n = 36)

PPV (n = 29)

P

27 (75.0) 1.09 1.00 6 (16.7)

14 (48.3) 1.13 1.01 9 (31.0)

0.029 (OR, 3.24; 95% CI, 1.12–9.17) 0.79 (MW) 0.90 (MW) 0.24 (F)

SSAS, single surgery anatomical success; F, Fisher exact test; MW, Mann–Whitney U-test.

1948 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES

15 patients combined from the 2 groups (23.1%) developed postoperative PVR with no significant difference between the PPV–SB group and the PPV group (16.7% PPV–SB vs. 31.0% PPV; P = 0.24) (Table 2). Patient age and lens status did not significantly affect visual outcomes or development of PVR for the two surgery groups. There was no difference between the surgical approaches in determining the BCVA at 3 months postprocedure, BCVA at final follow-up, or development of PVR for either patients aged 65 years and younger or patients older than 65 years (data not shown). Subgroup analysis of phakic and pseudophakic patients also showed no difference between the surgical groups in BCVA at any time or development of PVR (data not shown).

Discussion The purpose of this study was to compare interventions for the treatment of RRD at high risk for postoperative PVR, the most common cause of RRD repair failure. Surgical approaches for low-to-moderate complexity RDs have been well studied. However, less is known concerning comparative surgical outcomes in patients at high risk for PVR. This study reviewed 678 patients undergoing surgical repair of RRD between 2010 and 2012. Sixty-five patients were identified as being at high risk for PVR based on prespecified risk factors of RD in 2 or more quadrants, retinal tears .1 clock hour, preoperative PVR, or vitreous hemorrhage. Baseline characteristics of patients in each surgical group did not significantly differ. Pars plana vitrectomy combined with SB was found to have a significantly higher rate of SSAS compared with PPV alone for these high-risk patients. Visual acuity outcomes, however, were not significantly different at 3 months postprocedure or final follow-up. Reported surgical success rates for RD repair vary throughout the literature. Regardless of the specific surgical procedure, success rates among low-to-medium complexity patients have ranged from 68% to 99%.10,11,13,14,16–18,20–22 In contrast, our study of high-risk patients had a single surgery success rate of 63.1%. The primary reason for lower success rates in patients with high-risk baseline features is, as expected, a substantially higher rate of PVR development in this high-risk cohort: 3% to 12% in previous studies of lowto medium-risk patients compared with our rate of 23.1%, which confirmed that our patient population selected for prespecified characteristics was, in fact, at high risk for postoperative PVR.10–13,16,17,20–22 A number of RCTs have explored the surgical management for patients with uncomplicated RRDs



2014  VOLUME 34  NUMBER 10

with variable conclusions. Some randomized trials found no difference in SSAS between SB alone versus primary vitrectomy,10,14,23,24 whereas one study found that PPV had significantly higher attachment rates than SB alone.11 One trial found that for pseudophakic eyes, PPV had higher rates of reattachment than SB alone, but that for phakic eyes, no significant difference existed between the surgical approaches.17 However, in all of these RCT studies, eyes with PVR Grade C were excluded, and some studies excluded patients with vitreous hemorrhage or large tears, all of which were the inclusion criteria for this study. Also, differentiating this study from previous RCTs is the types of surgeries evaluated; we compared PPV–SB with PPV, whereas the majority of RCTs have compared SB alone to PPV. A number of retrospective studies have also evaluated ideal surgical management of RRDs and results have been conflicting. One study found that for phakic eyes, PPV–SB was associated with significantly higher anatomical success than PPV alone, although no difference was found for pseudophakic eyes.25 Other studies found no significant difference in reattachment rates for PPV–SB versus PPV alone, regardless of the lens status.13,15,16 One large retrospective study of 7,678 cases found that in uncomplicated RRDs, eyes treated with PPV alone had higher rates of anatomical success than those treated with simultaneous PPV–SB, regardless of the lens status.18 However, all the aforementioned retrospective studies of uncomplicated RRDs excluded patients with Grade C PVR, and many of these studies also excluded patients with vitreous hemorrhage or large tears, making comparison with this study more challenging. Compared with this study, the most similar previous study was performed by Adelman et al26 and retrospectively compared rates of surgical failure among 3,452 RRDs with complex features, defined as Grade B or C-1 PVR, large or giant tears, choroidal detachment or hypotony, and macular holes. Adelman et al found that for the 637 cases of RRD with Grade C PVR and for the 1,167 cases of RRD with large or giant retinal tears, a primary vitrectomy may be associated with higher anatomical surgical success compared with the combination of SB–PPV. Visual acuity outcomes for the study were not reported. In contrast, our study found that among patients at high risk for PVR—defined as preoperative PVR, RD .2 quadrants, tears .1 clock hour, and vitreous hemorrhage—the addition of a SB to a PPV was associated with significantly higher rates of success compared with patients treated with PPV alone. The reason for our differing results is unclear. Our study was not powered to detect differences in individual risk

PPV–SB VERSUS PPV IN PATIENTS AT HIGH RISK FOR PVR  STOREY ET AL

categories, such as preoperative PVR grades, and consequently all four risk categories for postoperative PVR are analyzed together, making our patient population different at baseline. Although Adelman et al likely included eyes with RD in .2 quadrants and vitreous hemorrhage, these patients were not delineated in the study, making comparison difficult. Finally, Adelman et al acknowledge that surgeons in their study may have added a SB for cases deemed more likely to fail, resulting in the appearance of a SB being associated with higher failure rates. Several previous studies have found an interaction between lens status and success of surgical approaches. One randomized trial, which excluded patients with high-risk characteristics including preoperative PVR and tears in .2 quadrants, found that SB achieved better functional success in phakic patients, whereas vitrectomy achieved better anatomical outcomes in pseudophakic patients.17 Adelman et al18 found that in phakic eyes with uncomplicated RRDs, failure rates were significantly lower for SBs compared with vitrectomy alone, but that in pseudophakic eyes, failure rates were similar between the interventions. In contrast, in this study, we found that lens status did not impact anatomical or visual outcomes differently for the two surgeries. In fact, although the differences were not statistically significant, SB trended toward superior anatomical success for both phakic and pseudophakic patients. Previous studies have also found a number of factors associated with anatomical and visual outcomes of RD repair. Greater duration of RD,27,28 older patient age,28–32 larger extent of RD,31–35 preoperative PVR,1,7,8,34,36,37 and vitreous hemorrhage5,6 have all shown to negatively impact surgical outcomes. Apart from patient age, this study did not show that any of the aforementioned characteristics affected the final outcome. However, this study was not powered to do so; thus, these observations cannot be overinterpreted. This study did find that treating patients at high risk for PVR with a combination PPV–SB was statistically significantly superior to PPV alone in patients aged 65 years and younger while the 2 procedures showed no difference for patients older than 65 years. An interpretation of these results suggests that as the vitreous gel becomes more syneretic, the benefit of the buckle declines. This finding may also provide a useful guideline for some surgeons because they plan surgical repair for high-risk patients. The pathophysiology of PVR is complex, with the involvement of various inflammatory cells and chemokines. If anatomical outcomes of patients at high risk for PVR are, in fact, significantly different depending on surgical selection, it is imperative that these patients

1949

must be correctly identified. For this study, we reviewed previously reported literature to identify characteristics consistently associated with the development of postoperative PVR. Our method depends on the accuracy of previously reported literature to correctly identify a target population for the interventions in question. However, our high rate of postoperative PVR does validate our inclusion criteria by affirming that the patients with baseline characteristics were indeed at high risk for PVR. With more advanced basic science research, a number of growth factors have been associated with the development of PVR, such as platelet-derived growth factor, hepatocyte growth factor, tumor necrosis factor, and vascular endothelial growth factor.38 Further research is needed to fully quantify the degree to which baseline characteristics and/or measurable growth factors are associated with the development of PVR to fully assess which patients are ideal candidates for specific surgical or medical treatments. Given the increasing use of vitrectomy and declining use of SB for primary RD repair, the results of this study are particularly notable.39 Improvement of instrumentation for vitrectomy surgery, shorter operating time, and decreased need for suturing have all contributed to increased preference of vitrectomy over SB. Although a surgeon’s comfort with a particular operation may also guide his or her choice, procedure selection should meet the needs of the individual patient and be based on the strength of clinical evidence. The strengths of this study are the inclusion of multiple surgeons across a single large retina practice, inclusion criteria based on well-established risk factors for postoperative PVR, and prespecified outcome variables evaluated after 3+ months of follow-up. This study has several limitations. Although 678 charts were reviewed, only 65 patients met the inclusion criteria, making the study population small. The few patients result in low statistical power to detect possible effects of baseline characteristics on outcomes. Multivariable analysis found no variable to significantly affect surgical outcomes. However, this negative finding after controlling for multiple baseline characteristics and interventions does not necessarily weaken our conclusion. We performed a relatively small exploratory study, which will hopefully lead to a larger study, focusing on patients at high risk for PVR. Retrospective nonrandomized studies can lead to selection bias when comparing two surgical techniques. It is possible that some surgeons are more experienced with one intervention than the other, which could lead to a selection and outcome bias. This study attempts to limit that bias by including all cases by all

1950 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES

surgeons across a single practice within a multi-year period. Some surgeons may elect to use a SB for more challenging cases. However, one would expect a bias toward inferior outcomes associated with SB, which was not the case in this study. Finally, surgical outcomes for RDs are affected by a number of preoperative, intraoperative, and postoperative factors, many of which are difficult to quantify. We evaluated factors known to affect surgical outcomes, but it is possible that other factors unaccounted for in this study affected treatment outcomes. This is the first study to date to evaluate PPV–SB versus PPV specifically for patients with RRD at high risk for PVR, and we found significant differences in anatomical outcomes. This study raises the question of whether an RCT for high-risk patients is warranted. Given that few previous studies have evaluated patients with high-risk characteristics and studies performed to date have had differing conclusions, we think that additional research on surgical interventions in patients at high risk for PVR is needed. Key words: pars plana vitrectomy, scleral buckle, proliferative vitreoretinopathy, retinal detachment.

12.

13.

14.

15.

16.

17.

18.

19.

References 1. Bonnet M. The development of severe proliferative vitreoretinopathy after retinal detachment surgery. Grade B: a determining risk factor. Graefes Arch Clin Exp Ophthalmol 1988; 226:201–205. 2. Laatikainen L, Harju H, Tolppanen EM. Post-operative outcome in rhegmatogenous retinal detachment. Acta Ophthalmol (Copenh) 1985;63:647–655. 3. Limb GA, Little BC, Meager A, et al. Cytokines in proliferative vitreoretinopathy. Eye (Lond) 1991;5:686–693. 4. Campochiaro PA. Pathogenic mechanisms in proliferative vitreoretinopathy. Arch Ophthalmol 1997;115:237–241. 5. Girard P, Mimoun G, Karpouzas I, et al. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina 1994;14:417–424. 6. Nagasaki H, Shinagawa K, Mochizuki M. Risk factors for proliferative vitreoretinopathy. Prog Retin Eye Res 1998;17:77–98. 7. Kon CH, Asaria RH, Occleston NL, et al. Risk factors for proliferative vitreoretinopathy after primary vitrectomy: a prospective study. Br J Ophthalmol 2000;84:506–511. 8. Cowley M, Conway BP, Campochiaro PA, et al. Clinical risk factors for proliferative vitreoretinopathy. Arch Ophthalmol 1989;107:1147–1151. 9. Arya AV, Emerson JW, Engelbert M, et al. Surgical management of pseudophakic retinal detachments: a meta-analysis. Ophthalmology 2006;113:1724–1733. 10. Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation—report no. 1. Ophthalmology 2005; 112:1421–1429. 11. Brazitikos PD, Androudi S, Christen WG, et al. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment

20.

21.

22.

23.

24.

25.

26.

27.

28.



2014  VOLUME 34  NUMBER 10

of pseudophakic retinal detachment: a randomized clinical trial. Retina 2005;25:957–964. Gartry DS, Chignell AH, Franks WA, et al. Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol 1993;77:199–203. Weichel ED, Martidis A, Fineman MS, et al. Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology 2006;113:2033–2040. Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand 2005;83:293–297. Schaal S, Sherman MP, Barr CC, et al. Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques. Retina 2011;31:1500–1504. Kinori M, Moisseiev E, Shoshany N, et al. Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol 2011;152:291–297.e2. Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 2007;114:2142–2154. Adelman RA, Parnes AJ, Ducournau D. Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1. Ophthalmology 2013;120:1804–1808. Holladay JT. Proper method for calculating average visual acuity. J Refract Surg 1997;13:388–391. Pastor JC, Fernandez I, Rodriguez de la Rua E, et al. Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the Retina 1 Project—report 2. Br J Ophthalmol 2008;92:378–382. Miki D, Hida T, Hotta K, et al. Comparison of scleral buckling and vitrectomy for retinal detachment resulting from flap tears in superior quadrants. Jpn J Ophthalmol 2001; 45:187–191. Afrashi F, Erakgun T, Akkin C, et al. Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks. Graefes Arch Clin Exp Ophthalmol 2004;242:295–300. Sun Q, Sun T, Xu Y, et al. Primary vitrectomy versus scleral buckling for the treatment of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled clinical trials. Curr Eye Res 2012;37:492–499. Soni C, Hainsworth DP, Almony A. Surgical management of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled trials. Ophthalmology 2013;120:1440–1447. Mehta S, Blinder KJ, Shah GK, et al. Pars plana vitrectomy versus combined pars plana vitrectomy and scleral buckle for primary repair of rhegmatogenous retinal detachment. Can J Ophthalmol 2011;46:237–241. Adelman RA, Parnes AJ, Sipperley JO, et al. Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2. Ophthalmology 2013;120:1809–1813. Ross WH, Kozy DW. Visual recovery in macula-off rhegmatogenous retinal detachments. Ophthalmology 1998;105: 2149–2153. Isernhagen RD, Wilkinson CP. Visual acuity after the repair of pseudophakic retinal detachments involving the macula. Retina 1989;9:15–21.

PPV–SB VERSUS PPV IN PATIENTS AT HIGH RISK FOR PVR  STOREY ET AL 29. Liu F, Meyer CH, Mennel S, et al. Visual recovery after scleral buckling surgery in macula-off rhegmatogenous retinal detachment. Ophthalmologica 2006;220: 174–180. 30. Mowatt L, Shun-Shin GA, Arora S, et al. Macula off retinal detachments. How long can they wait before it is too late? Eur J Ophthalmol 2005;15:109–117. 31. Burton TC, Lambert RW Jr. A predictive model for visual recovery following retinal detachment surgery. Ophthalmology 1978;85:619–625. 32. Ahmadieh H, Entezari M, Soheilian M, et al. Factors influencing anatomic and visual results in primary scleral buckling. Eur J Ophthalmol 2000;10:153–159. 33. Greven CM, Sanders RJ, Brown GC, et al. Pseudophakic retinal detachments. Anatomic and visual results. Ophthalmology 1992;99:257–262. 34. Heimann H, Zou X, Jandeck C, et al. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol 2006;244: 69–78. 35. La Heij EC, Derhaag PF, Hendrikse F. Results of scleral buckling operations in primary rhegmatogenous retinal detachment. Doc Ophthalmol 2000;100:17–25.

1951

36. Girard P, Karpouzas I. Pseudophakic retinal detachment: anatomic and visual results. Graefes Arch Clin Exp Ophthalmol 1995;233:324–330. 37. Salicone A, Smiddy WE, Venkatraman A, et al. Visual recovery after scleral buckling procedure for retinal detachment. Ophthalmology 2006;113:1734–1742. 38. Garweg JG, Tappeiner C, Halberstadt M. Pathophysiology of proliferative vitreoretinopathy in retinal detachment. Surv Ophthalmol 2013;58:321–329. 39. Jumper JM, Mittra RA. ASRS Preferences and Trends Survey, 2012. Available at: http://www.asrs.org/content/documents/ 2012_asrs_patsurvey_results.pdf. Accessed: October 4, 2013.

Appendix 1. Wills PVR Study Group: Rayan Al Shareef, William Benson, Char DeCroos, Jay Federman, Mitchell Fineman, David Fischer, Sunir Garg, Omesh Gupta, Julia Haller, Allen Ho, Jason Hsu, Richard Kaiser, Mohammed Khuthaila, Nikolas London, Joseph Maguire, Carl Park, Carl Regillo, Arunan Sivalingam, Marc Spirn, Philip Storey, William Tasman, James Vander.

Pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone for patients with rhegmatogenous retinal detachment at high risk for proliferative vitreoretinopathy.

To compare using pars plana vitrectomy (PPV) combined with a scleral buckle versus primary vitrectomy alone in patients with rhegmatogenous retinal de...
103KB Sizes 0 Downloads 4 Views