Skip to main content

Advertisement

SpringerLink
Log in

Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare the visual and anatomical outcomes of four surgical techniques to manage pseudophakic and aphakic retinal detachment (PARD).

Methods

In a multicenter randomized clinical trial, 211 eyes of 211 patients with PARD and proliferative vitreoretinopathy (PVR) grade B or less were randomly assigned to one of the four treatment groups: (1) scleral buckling (SB), 50 eyes, (2) vitrectomy without band, 51 eyes, (3) vitrectomy with encircling band (EB), 58 eyes, and (4) triamcinolone acetonide (TA) assisted vitrectomy, 52 eyes. Patients were followed for 12 months after the surgery. The best-corrected visual acuity (BCVA) and retinal reattachment rate at each follow-up time point were considered as the primary outcome measures. PVR, macular pucker, and cystoid macular edema were considered as the secondary outcomes.

Results

Visual improvement was achieved in all treatment groups relative to the baseline at all time points (all Ps < 0.001). There were no statistically significant differences among the groups with regard to BCVA changes. However, there was a significant difference in the slope of visual improvement curve: the SB group had a more rapid visual improvement compared to the vitrectomy with buckle group at month 12 (P = 0.032). The retinal reattachment rates at month 12 were 75, 64.7, 68.5, and 66.7 % in SB, vitrectomy without buckle, vitrectomy with EB, and TA-assisted vitrectomy groups respectively (P > 0.99). There were no statistically significant differences among the groups in terms of adverse events.

Conclusions

SB, TA-assisted vitrectomy, and vitrectomy with and without buckle had comparable outcomes in the management of PARD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Haimann MH, Burton TC, Brown CK (1982) Epidemiology of retinal detachment. Arch Ophthalmol 100:289–292

    Article  CAS  PubMed  Google Scholar 

  2. Ah-Fat FG, Sharma MC, Majid MA et al (1999) Trends in vitreoretinal surgery at a tertiary referral center: 1987 to 1996. Br J Ophthalmol 83:396–398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH, Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group (2007) Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114(12):2142–2154

    Article  PubMed  Google Scholar 

  4. Ho PC, Tolentino F (1984) Psuedophakic retinal detachment surgical success rate with various types of IOLs. Ophthalmology 91:847–852

    Article  CAS  PubMed  Google Scholar 

  5. Cousins S, Boniuk I, Okun E et al (1986) Pseudophakic retinal detachment in the presence of various IOL types. Ophthalmology 93:1198–1208

    Article  CAS  PubMed  Google Scholar 

  6. Yoshida A, Orgasawara H, Jalkh AE et al (1992) Retinal detachment after cataract surgery. Surgical results. Ophthalmology 99:460–465

    Article  CAS  PubMed  Google Scholar 

  7. Yoshida A, Ogasawara H, Jalkh A et al (1992) Retinal detachment after cataract surgery: predisposing factors. Ophthalmology 99:453–459

    Article  CAS  PubMed  Google Scholar 

  8. Wilkinson CP (1986) Pseudophakic retinal detachment. Retina 5:1–4

    Article  Google Scholar 

  9. Escoffery RF, Olk RJ, Grand MG, Boniuk I (1985) Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment. Am J Ophthalmol 99:275–281

    Article  CAS  PubMed  Google Scholar 

  10. Gartry DS, Chignell AH, Franks WA, Wong D (1993) Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced PVR. Br J Ophthalmol 77:199–203

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hakin KN, Lavin MJ, Leaver PK (1993) Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 231:344–346

    Article  CAS  PubMed  Google Scholar 

  12. Heimann H, Bornfeld N, Friedrichs W et al (1996) Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 234:561–568

    Article  CAS  PubMed  Google Scholar 

  13. Oshima Y, Emi K, Motokura M, Yamanishi S (1999) Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachment. Jpn J Ophthalmol 43:120–126

    Article  CAS  PubMed  Google Scholar 

  14. Brazitikos PD (2000) The expanding role of primary pars plana vitrectomy in the treatment of rhegmatogenous noncomplicated retinal detachment. Semin Ophthalmol 15:65–77

    Article  CAS  PubMed  Google Scholar 

  15. Bartz-Schmidt KU, Kirchhof B, Heimann K (1996) Primary vitrectomy for pseudophakic retinal detachment. Br J Ophthalmol 80:346–349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Brazitikos PD, D’Amico DJ, Tsinopoulos IT, Stangos NT (1999) Primary vitrectomy with perfluoron-octane use in the treatment of pseudophakic retinal breaks. Retina 19:103–109

    Article  CAS  PubMed  Google Scholar 

  17. Campo RV, Sipperly JO, Sneed SR et al (1999) Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology 106:1811–1816

    Article  CAS  PubMed  Google Scholar 

  18. Speicher MA, Fu AD, Martin JP, Von Fricken MA (2000) Primary vitrectomy alone for repair of retinal detachments following cataract surgery. Retina 20:459–464

    Article  CAS  PubMed  Google Scholar 

  19. Heimann H, Zou X, Jandeck C et al (2006) Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol 244(1):69–78

    Article  PubMed  Google Scholar 

  20. Schwartz SG, Flynn HW (2006) Primary retinal detachment: scleral buckle or pars plana vitrectomy. Curr Opin Ophthalmol 17(3):245–250

    Article  PubMed  Google Scholar 

  21. Ahmadieh H, Moradian S, Faghihi H, Pseudophakic and Aphakic Retinal Detachment (PARD) Study Group et al (2005) 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 112(8):1421–1429

    Article  PubMed  Google Scholar 

  22. Sharma YR, Karunanithi S, Azad RV et al (2005) Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand 83(3):293–297

    Article  PubMed  Google Scholar 

  23. Oshima Y, Yamanishi S, Sawa M et al (2000) Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol 44:538–549

    Article  CAS  PubMed  Google Scholar 

  24. Sun Q, Sun T, Xu Y et al (2012) Primary vitrectomy versus scleral buckling for the treatment of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled clinical trials. Curr Eye Res 37(6):492–499

    Article  PubMed  Google Scholar 

  25. Desai UR, Strassman IB (1997) Combined pars plana vitrectomy and scleral buckling for pseudophakic and phakic retinal detachments in which a break is not seen preoperatively. Ophthalmic Surg Lasers 28:718–722

    CAS  PubMed  Google Scholar 

  26. Deveny RG, de Carvalho NH (1999) Combined scleral buckle and pars plana vitrectomy as a primary procedure for pseudophakic retinal detachments. Ophthalmology 7:322–326

    Google Scholar 

  27. Weichel ED, Martidis A, Fineman MS et al (2006) Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology 113(11):2033–2040

    Article  PubMed  Google Scholar 

  28. Arya AV, Emerson JW, Engelbert M, Hagedorn CL, Adelman RA (2006) Surgical management of pseudophakic retinal detachments: a meta-analysis. Ophthalmology 113(10):1724–1733

    Article  PubMed  Google Scholar 

  29. Stangos AN, Petropoulos IK, Brozou CG et al (2004) Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment. Am J Ophthalmol 138(6):952–958

    Article  PubMed  Google Scholar 

  30. Soni C, Hainsworth DP, Almony A (2013) Surgical management of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled trials. Ophthalmology 120(7):1440–1447

    Article  PubMed  Google Scholar 

  31. Adelman RA, Parnes AJ, Ducournau D, European Vitreo-Retinal Society (EVRS) Retinal Detachment Study Group (2013) Strategy for the management of uncomplicated retinal detachments: the European Vitreo-Retinal Society Retinal Detachment Study report 1. Ophthalmology 120(9):1804–1808

    Article  PubMed  Google Scholar 

  32. Kinori M, Moisseiev E, Shoshany N et al (2011) Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol 152(2):291–297

    Article  PubMed  Google Scholar 

  33. Sakamoto T, Ishibashi T (2009) Visualizing vitreous in vitrectomy by triamcinolone. Graefes Arch Clin Exp Ophthalmol 247(9):1153–1163

    Article  CAS  PubMed  Google Scholar 

  34. Yamakiri K, Sakamoto T, Noda Y et al (2007) Reduced incidence of intraoperative complications in a multicenter controlled clinical trial of triamcinolone in vitrectomy. Ophthalmology 114(2):289–296

    Article  PubMed  Google Scholar 

  35. Sonoda KH, Sakamoto T, Enaida H et al (2004) Residual vitreous cortex after surgical posterior vitreous separation visualized by intravitreous triamcinolone acetonide. Ophthalmology 111(2):226–230

    Article  PubMed  Google Scholar 

  36. Ahmadieh H, Entezari M, Soheilian M et al (2000) Factors influencing anatomic and visual results in primary scleral buckling. Eur J Ophthalmol 10:153–159

    CAS  PubMed  Google Scholar 

  37. Greven CM, Sanders RJ, Brown GC et al (1992) Pseudophakic retinal detachments. Anatomic and visual results. Ophthalmology 99:257–262

    Article  CAS  PubMed  Google Scholar 

  38. Bonnet M (1988) The development of severe proliferative vitreoretinopathy after retinal detachment surgery. Grade B: a determining risk factor. Graefes Arch Clin Exp Ophthalmol 226:201–205

    Article  CAS  PubMed  Google Scholar 

  39. Sharma A, Grigoropoulos V, Williamson TH (2004) Management of primary rhegmatogenous retinal detachment with inferior breaks. Br J Ophthalmol 88(11):1372–1375

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Martínez-Castillo V, Verdugo A, Boixadera A, García-Arumí J, Corcóstegui B (2005) Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol 123(8):1078–1081

    Article  PubMed  Google Scholar 

  41. Martínez-Castillo V, Boixadera A, Verdugo A, García-Arumí J (2005) Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position. Ophthalmology 112(7):1222–1226

    Article  PubMed  Google Scholar 

  42. Michels RG (1990) Retinal detachment, 2nd edn. Mosby, St Louis, pp 1039–1040

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Siamak Moradian

  2. Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 16666, Iran

    Hamid Ahmadieh, Alireza Ramezani, Morteza Entezari & Mehdi Yasseri

  3. Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Hooshang Faghihi

  4. Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Touka Banaee

  5. Nikookari Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Ebadollah Heidari

  6. Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Hassan Behboudi

  7. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Mehdi Yasseri

Authors
  1. Siamak Moradian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamid Ahmadieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hooshang Faghihi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alireza Ramezani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Morteza Entezari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Touka Banaee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ebadollah Heidari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hassan Behboudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mehdi Yasseri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hamid Ahmadieh.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article. Authors do not have any financial relationship with the organization that sponsored the research.

The authors have full control of all primary data, and they agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Additional information

Clinical trial registration was done and it’s information is available at “www.clinicaltrials.gov” with study number of (NCT00370279).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moradian, S., Ahmadieh, H., Faghihi, H. et al. Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial. Graefes Arch Clin Exp Ophthalmol 254, 1743–1751 (2016). https://doi.org/10.1007/s00417-016-3318-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-016-3318-x

Keywords

Search

Navigation