An economy-based study: vitrectomy versus scleral buckle for primary rhegmatogenous retinal detachment in poor population

Abstract

Purpose The aim of this study was to compare scleral buckling (SB) and primary pars plana vitrectomy (PPV) for the treatment of primary phakic rhegmatogenous retinal detachment (RRD). Patients and methods A prospective interventional study was conducted in the Department of Ophthalmology, South Valley University, Egypt, between January 2013 and May 2016. Patients suffering from primary phakic RRD were recruited. Eyes were divided into two groups: the SB group and the PPV group. The SB group underwent radial or encircling silicone sponge retinopexy with cryopexy, and evacuation of subretinal fluid in most cases with air injection. The PPV group underwent three-port 20-G PPV with sulfur hexafluoride or silicone oil (SO) as endotamponade agents. Cost was estimated for the vitreoretinal surgery, cataract surgery, and SO removal. Main outcome measures were anatomical and visual outcome, reoperation rate, and cost of initial surgery and reoperations. Results Forty-five eyes of 45 patients were included in the present study. Primary anatomical success was achieved in 17 (85%) eyes in the SB group and in 21 (84%) eyes in the PPV group. The final anatomical success rate was achieved in all eyes (100%) in both groups. The final best-corrected visual acuity improved in 14 (70%) eyes in the SB group and in 17 (68%) eyes in the PPV group. Reoperations included retinal reattachment surgery in three (15%) eyes versus four (16%) eyes in the SB and PPV groups, respectively. Cataract extraction with intraocular lens implantation was performed in four (20%) eyes in the SB group versus 16 (64%) eyes in the PPV group, and SO removal was performed in 12 (48%) eyes in the PPV group. SB operation cost was 4960 Egyptian Pounds, whereas PPV surgery cost was 6160 Egyptian Pounds. Conclusion SB and PPV for the treatment of RRD had comparable results as regards anatomical and functional outcomes. When considering other factors to decide which treatment method is better, such as cost of surgery, SB seems to be of lower cost compared with PPV.