Participants
129 eyes treated with SB or PPV with WAVS for RRD were included.
The Ethical Committee of Pusan National University Hospital approved this study in accordance with the rules set forth in the Helsinki Declaration. A retrospective review was performed on the medical records of patients who underwent either SB or PPV for RRD and were followed up at least 3 months in Pusan National University Hospital from Jan. 2011 to Sep. 2013.
Patients younger than 35 years were excluded from the present study because the primary procedure in our hospital is SB for uncomplicated RRD in patients younger than 35 year-old, as our database indicates that they have a high success rate. Moreover, vitrectomy for younger patients may cause postoperative cataract progression and subsequent loss of accommodation after cataract surgery. In addition, an epidemiologic study revealed two peaks in the incidence of RRD [
10], suggesting an alternative mechanism underlying the cause of PVD in younger patients [
11].
RRD complicated with severe media opacity, proliferative vitreoretinopathy grade C, posterior retinal break, or pseudophakia were defined as complicated and excluded. If the patients underwent combined PPV with SB, or had attached fovea or other ocular disease impacting visual acuity (VA), they were also excluded.
Patients treated with SB were classified as group B, while vitrectomy with WAVS was classified as group V. SB was combined with cryoretinopexy in all cases. Subretinal fluid (SRF) was drained and/or gas was injected into the vitreous cavity at each surgeon’s discretion. PPV was performed using Accurus (Alcon, Fort Worth, TX, USA). The fundus was visualized using WAVS: BIOM (Oculus, Wetzlar, Germany) or Resight 700 (Carl Zeiss Meditec AG, Jena, Germany). The 23- or 25-gauge cutters were used at a rate of 2,500–5,000 cuts per minute. Cataract surgery was performed concurrently to prevent postoperative cataract progression with patient consent. If necessary to confirm the presence of PVD or epiretinal membrane (ERM), triamcinolone acetonide was applied during the PPV. For shaving peripheral vitreous, an assistant indented the sclera.
Prophylactic photocoagulation was applied only around retinal breaks or lesions predisposed to retinal detachment, not on normal looking retina. Sulfur hexafluoride (SF6), octafluoropropane (C3F8), room air, or silicone oil were used as tamponade at the surgeon’s discretion.
The baseline characteristics evaluated included age, preoperative VA, detachment area, symptoms duration, number of breaks, intraocular pressure, presence of a tear larger than 0.5 disc diameters, and presence of PVD. Detachment area was measured as clock hours at the equator. Presence of PVD was evaluated in group V during PPV.
Primary success was defined as the retina maintaining reattached for at least 3 months after the primary surgery. Localized small SRF without an increase during follow-up was not considered surgical failure. Macular complication was defined as full-thickness macular hole or ERM that required surgical intervention. Sustained submacular fluid (SMF) was defined as SRF persisting in the macula detected using spectral-domain optical coherence tomography (OCT) at 3 months or later.
Primary success rate, VA, macular complication, operation time and sustained SMF were compared between the two groups. VA, age, symptom duration, number of breaks, detachment area, intraocular pressure, operation time, and follow-up duration were compared using the Mann–Whitney U test, and categorical variables, including sex, presence of tear, and primary success, macular complication, and sustained SMF using Chi-square test or Fisher’s exact test. Statistical analyses were performed using IBM SPSS Statistics 21, (IBM Inc., Armonk, NY, USA) setting the level of statistical significance at P < 0.05.