Surgical management in retinal detachment with difficult retinal break configuration. Conventional buckling surgery or primary vitrectomy?

Background. We retrospectively evaluated 100 difficult cases out of 803 con secutive eyes with retinal detachment in order to determine the best surgic al procedure in cases with difficult break configurations such as multiple, large, and central holes. Methods. We treated the eyes either with conventional buckling surgery (n=6 0) encircling buckle (EB) plus sponge exoplant (SP) (n=45) or multiple spon ge exoplants (n=15) or with primary vitrectomy (PV) (n=40). From the 40 pat ients in the PV group, 10 underwent vitrectomy plus intraocular gas only, i n the other cases an encircling band was used (n=30). Results. In the EB/SP group the retina was attached directly after surgery in 59/60 cases. During a mean follow-up of 14.5 months redetachment occurre d in 4/60 cases. In the PV group the retina was attached in 37/40 cases aft er resorption of gas and during the mean follow-up of 9.3 months redetachme nt occurred in an additional 4/40 cases. Complications during surgery in th e EB/SP group were retinal incarceration (n=2) and subretinal hemorrhage (n =2). In the PV group intraoperative complications included choroidal detach ment (n=1) and iatrogenic holes (15%). Postoperative complications were cho roidal detachment in 6/60 vs 0/40, transitory increased intraocular pressur e (30% vs 68%). Double vision, however correctable by means of prisms, occu rred in 4/60 vs 0/40. Conclusions. The primary attachment rate is high and similar with both proc edures. The spectrum of intra-and postoperative complications is however di fferent between both groups.