An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment

Authors

  • Seang-Mei Saw,

    1. Department of Community, Occupational and Family Medicine, National University of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
    2. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
    3. Singapore Eye Research Institute, Singapore
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  • Gus Gazzard,

    1. Institute of Ophthalmology, London, UK
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  • Ajeet M. Wagle,

    1. The Eye Institute at Alexandra Hospital, National Healthcare Group, Singapore
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  • Jimmy Lim,

    1. The Eye Institute at Tan Tock Seng Hospital, National Healthcare Group, Singapore
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  • Kah-Guan Au Eong

    1. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
    2. Singapore Eye Research Institute, Singapore
    3. The Eye Institute at Alexandra Hospital, National Healthcare Group, Singapore
    4. The Eye Institute at Tan Tock Seng Hospital, National Healthcare Group, Singapore
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Assistant Professor Seang-Mei Saw
Department of Community, Occupational
and Family Medicine
Yong Loo Lin School of Medicine
National University of Singapore 16 Medical
Drive Singapore
117597 Singapore
Tel: + 65 6516 4989
Fax: + 65 6779 1489
Email: cofsawsm@nus.edu.sg

Abstract.

Purpose:  To evaluate the various surgical interventions available for uncomplicated rhegmatogenous retinal detachment.

Methods:  Reports of controlled clinical trials of surgical interventions (pneumatic retinopexy, scleral buckling and vitrectomy) for uncomplicated rhegmatogenous retinal detachment indexed in MEDLINE from 1968 to January 2006 were included. The primary outcomes evaluated included single-operation reattachment rates, multiple reoperation reattachment rates and improvements in visual acuity (VA).

Results:  We found five controlled trials (two randomized) comparing the efficacy of pneumatic retinopexy versus scleral buckling. The single-operation reattachment rates were higher for scleral buckling, but the final reattachment rates were similar. We found nine controlled trials (four randomized) evaluating vitrectomy. There were no statistically significant differences between retinal reattachment rates or final visual acuities, except in one randomized and one non-randomized controlled trial in which the VAs were significantly better in the vitrectomy than the scleral buckling group.

Conclusions:  Pneumatic retinopexy is a possible alternative to scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment. The rates of missed or new retinal breaks after pneumatic retinopexy, however, are higher than following scleral buckling. The clinical outcomes of vitrectomy for rhegmatogenous retinal detachment compare favourably.

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