Primary Retinal Detachment Outcomes Study Report Number 2: Phakic Retinal Detachment Outcomes

Abstract Objective Anatomically similar rhegmatogenous retinal detachments (RRDs) can be treated with scleral buckle (SB), pars plana vitrectomy (PPV), or scleral buckle combined with vitrectomy (PPV/SB). This study compares moderately complex phakic primary RRD treated with SB, PPV, or PPV/SB to review anatomic and visual outcomes. Design Multicenter, retrospective, interventional cohort study. Subjects, Participants, and/or Controls Data were gathered on all patients from multiple retina practices in the United States with RRD in 2015 and > 90 days of follow-up. The cohort of phakic patients with moderately complex RRD was analyzed. Methods, Intervention, or Testing A large and detailed database was generated. Eyes with findings that would bias towards PPV (vitreous hemorrhage, dense cataract, proliferative vitreoretinopathy, giant retinal tear, among others) were excluded. Age Main Outcome Measures Single surgery anatomic success (SSAS), defined as retinal attachment with no other RRD surgery within 90 days, is the main outcome measure. Final visual acuity is the secondary outcome measure. Pearson’s X2 and ANOVA were used to test treatment effect of surgery type on SSAS and vision. Results SSAS was noted in 155/169 SB cases (91.7%), in 207/249 PPV cases (83.1%), and in 271/297 PPV/SB cases (91.2%). SB and PPV/SB were superior to PPV for SSAS (P = 0.0041). For macula-on or split cases, SB had significantly better visual outcomes than PPV or PPV/SB even after controlling for cataract (cases with minimal cataract at final follow-up, or post cataract surgery) (P Conclusions For phakic moderately complex primary RRDs in this study of PPV vs. SB vs. PPV/SB, SB had the best visual outcomes and PPV had the worst SSAS outcomes.