Combined vitrectomy and scleral buckle versus vitrectomy with heavy silicone oil tamponade in the management of primary rhegmatogenous retinal detachment with inferior proliferative vitreoretinopathy

Abstract

Purpose The aim was to compare the anatomical and functional success between combined scleral buckling with pars plana vitrectomy (PPV) and PPV with heavy silicone oil (HSO) tamponade in treating inferior proliferative vitreoretinopathy (PVR) grade C in primary rhegmatogenous retinal detachment. Patients and methods A nonrandomized comparative study was performed on 33 eyes of 33 patients presenting with inferior PVR grade C complicating primary rhegmatogenous retinal detachment. Sixteen eyes underwent PPV with the HSO tamponade namely Densiron 68 that were classified as the heavy-oil group; 17 eyes underwent combined PPV with an encircling 240-band that were classified as the buckle-vitrectomy group. The aim was to achieve anatomical retinal reattachment in the absence of intraocular tamponade. Silicone oil (SO) was removed after 8 weeks in both groups. All patients were evaluated for best corrected visual acuity (BCVA) and intraocular pressure by the end of the first week, first and second months in oil-filled eyes; by the end of the first and third months post-SO removal was achieved. Results Successful primary retinal reattachment was achieved in 87.5% in the heavy-oil group and in 94.1% in the buckle-vitrectomy group, which showed no statistical difference (P=0.47) in these groups. Both groups showed a statistically significant improvement in BCVA after surgery. A significant difference in BCVA in the two groups on the eighth follow-up week after primary surgery (P=0.015) and on the 4th follow-up week after SO removal (P=0.031) was found; but at the 12th week post-SO removal there was no significant difference found between both groups (P=0.056). The mean surgical time was 96.25±13.478 and 116.47±12.4 min for the heavy-oil and buckle-vitrectomy groups, respectively, with a P value less than 0.001. Conclusion Managing inferior PVR either by PPV and HSO or by PPV and an encircling band achieved the same anatomical and functional reuslts. Although the surgical time was much faster in the heavy-oil group, the surgical costs were much higher.