A Comparative Study of Visual Outcomes Following Primary Vitrectomy and Scleral Buckling Procedures to Manage Macular-off Rhegmatogenous Retinal Detachments

Abstract

To determine the difference between two types of retinal detachment surgery in postoperative visual recovery in the management of macular-off rhegmatogenous retinal detachment. We evaluated retrospectively the postoperative visual acuity (VA) in 37 patients who underwent primary vitrectomy (group V) and 39 patients treated with conventional scleral buckling (group S). Although the mean preoperative VA in group V (0.03) was significantly worse (p = 0.04) than that in group S (0.06), there was no statistically significant difference between the groups in postoperative VA throughout the follow-up period. However, in the cases with poor preoperative VA (VA < 0.1), ocular hypotony (IOP < 7 mmHg), or prolonged macular detachment (duration > 7 days), the visual recovery was significantly better (p < 0.05) in group V than in group S from 1 month postoperatively. There were more eyes with a final VA of more than 0.5 in group V than in group S. When considering only the eyes with lenses spared intraoperatively, postoperative cataract progression resulting in secondary visual reduction was statistically significantly greater (p < 0.01) in group V (62%) than in group S (8%). Primary vitrectomy is effective to attain early visual rehabilitation, especially to manage macula-off retinal detachments with poor preoperative VA, ocular hypotony, and prolonged macular detachment. To prevent a secondary visual reduction, cataract surgery combined with vitrectomy is recommended in selected cases.