COMPARISON OF PNEUMATIC RETINOPEXY AND SCLERAL BUCKLING IN THE MANAGEMENT OF PRIMARY RHEGMATOGENOUS RETINAL-DETACHMENT

PURPOSE: To compare pneumatic retinopexy and scleral buckling for repa ir of primary rhegmatogenous retinal detachment with respect: to visua l outcome, single-procedure reattachment rate, and development of prol iferative vitreoretinopathy METHODS: A consecutive series of eyes init ially treated with pneumatic retinopexy (n = 56) between March 1986 an d February 1996 were compared with a selected group of eyes treated wi th scleral buckling (n = 86) with similar location and distribution of retinal breaks and absence of proliferative vitreoretinopathy, A regr ession model was developed to adjust for underlying differences betwee n treatment groups, resulting in a cohort of 50 eyes in each group for final comparison. A minimum follow-up of 6 months was obtained. RESUL TS: Single-procedure reattachment rare was significantly higher for sc leral buckle eyes (42 of 50 eyes, 84%) than for pneumatic retinopexy e yes (31 of 50 eyes, 62%; P less than or equal to.01), Correspondingly, reoperation rate was significantly higher for pneumatic retinopexy ey es (19 of 50 eyes, 38%) than for scleral buckle eyes (7 of 50 eyes, 14 %; P less than or equal to.01). Multiple regression analysis evaluatin g perioperative factors demonstrated that the use of pneumatic retinop exy was the sole factor predictive of retinal detachment after a singl e procedure (relative odds = 2.20, P =.02). Final reattachment rate, a fter reoperations, was 98% (49 of 50 eyes) in each group. Except for n onphakic eyes, final visual outcome and rate of postoperative prolifer ative virreoretinopathy development did not differ significantly betwe en the two procedures. CONCLUSIONS: In phakic eyes, pneumatic retinope xy was associated with a significantly higher reoperation rate than sc leral buckling, but resulted in equivalent final visual outcome and re attachment rare after reoperations. If used, it must be incorporated i nto a strategy in which patient and physician are prepared for a great er chance of reoperation compared to initial management with scleral b uckling. (Am J Ophthalmol 1998;126: 658-668. (C) 1998 by Elsevier Scie nce Inc, All rights reserved.).