A comparative study of visual outcomes following primary vitrectomy and scleral buckling procedures to manage macular off rhegmatogenous retinal detachments

Objective: To determine the difference between two types of retinal detachment surgery in postoperative visual recovery in the management of macular-off rhegmatogenous retinal detachment.

Methods: We evaluated retrospectively the postoperative visual acuity (VA) in 37 patients who underwent primary vitrectomy (group V) and 39 patients treated with conventional scleral buckling (group S).

Results: Although the mean preoperative VA in group V (0.03) was significantly worse (p = 0.04) than that in group S (0.06), there was no statistically significant difference between the groups in postoperative VA throughout the follow-up period. However, in the cases with poor preoperative VA (VA < 0.1), ocular hypotony (IOP < 7 mmHg), or prolonged macular detachment (duration > 7 days), the visual recovery was significantly better (p < 0.05) in group V than in group S from 1 month postoperatively. There were more eyes with a final VA of more than 0.5 in group V than in group S. When considering only the eyes with lenses spared intraoperatively, postoperative cataract progression resulting in secondary visual reduction was statistically significantly greater (p < 0.01) in group V (62%) than in group S (8%).

Conclusions: Primary vitrectomy is effective to attain early visual rehabilitation, especially to manage macula-off retinal detachments with poor preoperative VA, ocular hypotony, and prolonged macular detachment. To prevent a secondary visual reduction, cataract surgery combined with vitrectomy is recommended in selected cases.