141st APHA Annual Meeting and Exposition

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281141
Scleral buckling versus primary vitrectomy in patients with rhegmatogenous retinal detachment at high risk for failure to reattach


Tuesday, November 5, 2013

Philip Storey, MD, MPH, Department of Research, Wills Eye Institute, Philadelphia, PA
Natalie Fang-Yen, BA, Retina Department, Wills Eye Institute, Philadelphia, PA
Rayan Al Shareef, MD, Retina Department, Wills Eye Institute, Philadelphia, PA
Mohammed Khuthaila, MD, Wills Eye Institute, Philadelphia, PA
Nikolas London, MD, Retina Department, Wills Eye Institute, Philadelphia, PA
Char DeCroos, MD, Wills Eye Institute, Philadelphia, PA
Benjamin Leiby, PhD, Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA
Richard Kaiser, MD, Retina Department, Wills Eye Institute, Philadelphia, PA
Background: Rhegmatogenous retinal detachment (RRD) is caused by separation of the neurosensory retina from the underlying retinal pigment epithelium and is a potentially blinding condition. RRD can be surgically treated with scleral buckling (SB) or pars plana vitrectomy (PPV). In recent years, a number of studies have evaluated SB with or without PPV versus PPV alone for patients with RRD. However, all major randomized controlled trials and the majority of reviews have excluded patients at high risk for failure to reattach.

Methods: In a retrospective, nonrandomized study, 678 patients were identified from billing data as having RRD between April 1, 2010 and August 1, 2012 at one large retina practice. Patients were considered at high risk for failure to reattach if they presented with RRD in 2+ quadrants, retinal tears larger than 1 clock hour, preoperative proliferative vitreoretinopathy (PVR), or vitreous hemorrhage.

Results: 75 patients were identified as being at high risk for failure to reattach and were followed for a mean of 5.3 months. Patients treated with SB (n=44) were significantly more likely to have anatomic success after a single surgery compared to those treated with PPV alone (n=31) (75.0% for SB vs. 51.6% for PPV alone; p=0.049). Development of PVR and best-corrected visual acuity at 3 months post-procedure and final follow-up were not significantly different between the two treatment groups.

Conclusion: For patients with RRD at high risk for failure to reattach, SB was associated with significantly higher anatomical success rates compared to PPV alone.

Learning Areas:

Basic medical science applied in public health
Clinical medicine applied in public health
Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
Compare surgical treatments for patients with rhegmatogenous retinal detachment at high risk for failure to reattach

Keyword(s): Vision Care, Treatment Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked as a post-baccalaureate student and research assistant on multiple studies evaluating the safety and efficacy of medical and surgical interventions for retinal disease. Among my scientific interests are outcome results from clinical studies applied to the public health sphere.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4276.1: Vision and eye health