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 consecutive eyes with retinal detachment in order to determine the best surgical 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=60) encircling buckle (EB) plus sponge exoplant (SP) (n=45) or multiple sponge exoplants (n=15) or with primary vitrectomy (PV) (n=40). From the 40 patients in the PV group, 10 underwent vitrectomy plus intraocular gas only, in 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 occurred in 4/60 cases. In the PV group the retina was attached in 37/40 cases after resorption of gas and during the mean follow-up of 9.3 months redetachment occurred in an additional 4/40 cases. Complications during surgery in the EB/SP group were retinal incarceration (n=2) and subretinal hemorrhage (n=2). In the PV group intraoperative complications included choroidal detachment (n=1) and iatrogenic holes (15%). Postoperative complications were choroidal detachment in 6/60 vs 0/40, transitory increased intraocular pressure (30% vs 68%). Double vision, however correctable by means of prisms, occurred in 4/60 vs 0/40. Conclusions. The primary attachment rate is high and similar with both procedures. The spectrum of intra-and postoperative complications is however different between both groups.