Combined scleral buckle and pars plana vitrectomy as a primary procedure for pseudophakic retinal detachments

BACKGROUND AND OBJECTIVE: Pseudophakic and aphakic retinal detachments are associated with a lower percentage of successful primary repair with standa rd scleral buckling surgery, than phakic retinal detachments. The objective of this study was to determine whether a combined scleral buckle and vitre ctomy, as a primary procedure, offers any advantage over conventional scler al buckling in primary pseudophakic and aphakic retinal detachments, withou t proliferative vitreoretinopathy. MATERIALS AND METHODS: This was a prospective, non-randomized clinical stud y. Ninety-four consecutive pseudophakic and aphakic retinal detachments wer e included in the study. All patients were operated upon by the same surgeo n. Each patient underwent a combined scleral buckle and pars plana vitrecto my with perfluorocarbon injection and air-fluid exchange. Each patient was followed by the operating surgeon for a minimum of 6 months. Patients were followed with respect to anatomic reattachment, visual acuity improvement, and surgical complications. RESULTS: All eyes were anatomically reattached after a single operation. Al l demonstrated an increase in their visual acuity, and there were no compli cations attributable to the vitrectomy procedure. CONCLUSIONS: We conclude that such a combined approach to primary pseudopha kic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resultin g in fewer missed peripheral breaks, and a lower likelihood of proliferativ e vitreoretinopathy. We recommend this combined surgical approach for all p rimary pseudophakic and aphakic retinal detachments.