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Purpose: To evaluate real‐world evidence for young Japanese patients with rhegmatogenous retinal detachment (RRD) by retrospectively examining surgical procedures and clinical outcomes in the Japan Clinical Retina Study group. Methods: This was a multicentre retrospective study of the medical records of 562 young patients (384 males and 178 females; mean age: 33.0 ± 11.8 years) who had been diagnosed with RRD and who underwent surgical procedures in participating centres during the period between April 2013 and August 2016. Results: The selected surgeries were scleral buckling (SB) for 295 eyes (49.7%) and pars plana vitrectomy (PPV) for 262 eyes (44.1%). Between the two surgical procedures, there was no significant difference in the primary anatomical reattachment rate (PARR, SB = 92.2%, PPV = 93.9%); improvements in vision were noted in both groups. The incidences of proliferative vitreoretinopathy and cataract formation within 1 year of PPV were 2.3% (p = 0.0047) and 6.5% (p = 0.0005), whereas they were 0% and 1.0% in the SB group, respectively. Conclusion: Scleral buckling (SB) and PPV were chosen with almost equal frequency for young patients with RRD. Clinical outcomes for SB and PPV exhibited a similar PARR. The incidence of cataract formation after PPV may constitute an important limitation of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS‐OCT) and in vivo confocal microscopy (IVCM). Methods: Twenty RRD eyes were consecutively enrolled. AS‐OCT was performed at RRD diagnosis (RRD‐D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD‐D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra‐scleral hypo‐reflective spaces area (MIHSA) at AS‐OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra‐ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. Results: Rhegmatogenous retinal detachment‐ diagnosis (RRD‐D) overall‐mean intra‐scleral hypo‐reflective spaces (MISHA), ‐MMD and ‐MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall‐, AQ‐ and UQ‐MISHA further increased (p < 0.05), whereas overall‐MMD and ‐MMA did not change. At all follow‐up, AQ and UQ parameters did not show significant differences between them. RRD‐D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week‐1, month‐1 and ‐6 IOP was significantly lower than RRD‐D (p < 0.05). Rhegmatogenous retinal detachment‐ diagnosis (RRD‐D), 1‐ and 6‐month overall and AQ‐MISHA and AQ‐MMD negatively correlated with IOP (p < 0.05). Conclusion: Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB. [ABSTRACT FROM AUTHOR]

Purpose In this retrospective study we evaluated the anatomic outcomes of scleral buckling (SB) versus re-vitrectomy for the treatment of recurrent inferior retinal detachment ( RD) in silicone oil (SiO) tamponade eyes after primary vitrectomy. Methods There were 103 patients (103 eyes) enrolled in this study. All patients had recurrent inferior RD in the SiO-filled eyes within 6 months after the primary vitrectomy, and were treated by either SB or re-vitrectomy. Patients were divided into two groups based on different surgical procedures: the SB group (49 eyes) and the re-vitrectomy group (54 eyes). Anatomic reattachment of the retina was measured after reoperation. Based on different retinal proliferation states in different postoperative periods after primary vitrectomy, we also compared the anatomic outcomes of the two surgical procedures in two specific postoperative periods, early period (≤1 month) and late period (1-6 months). Results The SB and re-vitrectomy groups exhibited similar retinal reattachment rate (65.3% versus 72.2%, p = 0.449) after reoperation. In the re-vitrectomy group, the retinal reattachment rate was similar in the early period and the late period (70.8% versus 73.3%, p = 0.839). However, the retinal reattachment rate was significantly higher in the early period than that of the late period (80.8% versus 47.8%, p = 0.016) in the SB group. In the early surgery groups, the retinal reattachment rate was similar in the SB group compared to the re-vitrectomy group (80.8% versus 70.8%, p = 0.411). While in the late surgery groups, retinal reattachment rate was trended higher in the re-vitrectomy group compared to the SB group (73.3% versus 47.8%, p = 0.058). Conclusion For recurrent inferior RD in SO-filled eyes, SB surgery provides similar therapeutic effectiveness with satisfactory anatomic outcomes compared to the re-vitrectomy. For eyes with recurrent inferior RD in the early period (≤1 month) after primary vitrectomy, SB surgery may be a better choice since it causes less complication; while in the late period (1-6 months) after primary vitrectomy, re-vitrectomy may be recommended, especially for the eyes with severe anterior proliferative vitreoretinopathy and retinal foreshortening. [ABSTRACT FROM AUTHOR]

Purpose To report the results and complications of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using 25-gauge chandelier endoillumination. Methods A total of 61 patients (61 eyes) with RRD were treated with scleral buckling. For the sclera buckling procedure, a 25-gauge chandelier was inserted through the pars plana for intra-ocular illumination, and retinal tears were identified and treated with episcleral cryotherapy under surgical microscope. On postoperative days 1, 3 and 7, the intra-ocular pressure was measured by a non-contact tonometer. On postoperative months 1 and 3, ultrasound biomicroscopy was used to examine the pars plana incision. Results In the surgical procedure, there was no lenticular or retinal damage due to the chandelier insertion. There was no conjunctival bleb formation at pars plana incision and no incidence of endophthalmitis after surgery. The mean intra-ocular pressure was 15.74 ± 2.98, 15.83 ± 2.76 and 16.14 ± 2.52 mmHg on postoperative days 1, 3 and 7, respectively. The one-time retinal reattachment rate was 93.4%. No visible vitreous incarceration was found in the incision of the pars plana. Conclusion There was no complication found due to the chandelier insertion in early postoperative period. Chandelier endoillumination is a feasible method for retinal visualization under surgical microscope during scleral buckling. [ABSTRACT FROM AUTHOR]

Purpose: To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. Methods: This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s). Results: In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34–48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35–56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically. Conclusion: With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment. [ABSTRACT FROM AUTHOR]

. Purpose: The 'Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study' (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes. Methods: Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods. Results: In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p < 0.0001), break extension > 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229). Conclusion: Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate the anatomical success rate of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and to evaluate the differences in outcome between patients suffering macula-off retinal detachment and those without a macular involvement. Methods: As a retrospective interventional case series, Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) is one of the largest ever established of retinal detachment patients and their outcome after buckling surgery, with 4325 patients who underwent surgery between 1980 and 2001. In 53.94% ( n = 2134) of 3956 patients with nontraumatic retinal detachment, the macula was involved. The main outcome measure was the achievement of dry anatomical attachment of the retina. Results: The success rate in patients with macula-off retinal detachment is 80.46% and thus 7.78% lower (p < 0.01) than that in those patients with their macula intact whose success rate amounted to 88.24%. The overall success rate of all 4325 MUSTARD patients was 83.98%. Conclusions: Scleral buckling is an established and mostly successful method for the treatment of retinal detachment. As our case series has demonstrated, even eyes with macula-off can be treated successfully by this procedure, thereby avoiding the complications of primary vitrectomy. [ABSTRACT FROM AUTHOR]

. Purpose: To identify risk factors that may lead to reoperations following primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). Methods: Analysis of the association between distinct parameters and the necessity for reoperations in the 'Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study' (SPR Study) using an Andersen-Gill-mean intensity model. Results: The risk for recurrent reoperations is significantly reduced by primary vitrectomy (PV) compared to scleral buckling (SB) in pseudophakic eyes (p = 0.0009) and increased after PV compared to SB in phakic eyes (p < 0.0001). Additional significant risk factors were in the pseudophakic group preoperative deterioration of visual acuity (p = 0.0226), YAG capsulotomy (p = 0.0043), large breaks (p = 0.0290), number of affected quadrants (p = 0.0387), retinal incarceration during surgery (p = 0.0115), number of breaks (p < 0.0001) and symptomatic visual field defect (p = 0.0463). In the phakic group, associated risk factors were low intraocular pressure (p = 0.0013) and persistent intraoperative detachment at the buckle (p = 0.0184). Conclusion: Reoperations are used as an indicator for the quality and efficacy of surgical techniques. Using a refined multivariate survival model, distinct factors were identified and associated with one or more reoperations after PV or SB in RRD surgery. This information should be useful in the decision process regarding the surgical approach. [ABSTRACT FROM AUTHOR]

Purpose: The preoperative and intraoperative clinical variables associated with redetachment and/or a poor visual outcome following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) have mainly been studied after a short follow-up. This study aimed to analyse long-term effects by following patients for at least 6 months. Methods: In a retrospective survey we evaluated the data of 436 eyes that underwent SB surgery. Postoperative data were collected at 3-month intervals. Results: After a mean follow-up period of 51 months, anatomic reattachment was achieved in 76% after one SB procedure, with a final reattachment rate of 97% after additional vitreoretinal procedures. In total, 104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up, 32 eyes (7%) and 20 eyes (5%), respectively, developed redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. A cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent RRD. Conclusion: Conventional SB surgery is a reliable procedure in a selected group of eyes with primary RRD. However, in eyes with a retinal tear with a cumulative size of more than three disc diameters, a primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 months, a longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after SB surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether choroidal thickness (CT) is associated with persistent subretinal fluid (pSRF) after simple primary rhegmatogenous retinal detachment (RRD) repair. Methods: This single‐centre, retrospective, observational study included patients who underwent RRD repair with at least 12‐month follow‐up. Preoperative and postoperative parameters were evaluated for association with pSRF. CT measurements were obtained at the central 1 mm area on enhanced depth imaging (EDI) OCT scans, using a semiautomatic method. Multiple logistic regression analyses were assessed to determine predictive factors for pSRF. Results: Overall, 100 eyes of 100 patients, mean age of 59.9 ± 12.6 years were included. pSRF was found in 21.0% of eyes and resolved over time in 85.7% of eyes at 12 months. In the pSRF group both RRD and fellow eyes showed lower mean choroidal and RPE thickness values as compared to those without pSRF (p < 0.05). A significant correlation was found between pSRF occurrence and choroidal thinning (p = 0.02). After multiple regression analyses, macula‐off RRD (p = 0.005) and scleral buckling (SB) technique (p = 0.001) were retained as final predictors for pSRF. In macula‐off SB eyes, detachment duration was the only factor associated with pSRF (p = 0.046). There were no significant differences in best‐corrected visual acuity outcomes between the pSRF and the no‐pSRF eyes. Conclusions: Patients with pSRF showed lower choroidal and RPE thickness as compared to those without pSRF. CT did not turn out to be a final predictor for pSRF, as this was mainly associated with macular involvement, surgical technique and detachment duration. [ABSTRACT FROM AUTHOR]

Purpose: To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011–2013. Method: All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011–2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal. Results: In total, 918 primary retinal detachments were recorded during the 3‐year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re‐detachment during the 6‐month follow‐up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re‐detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure – alone or in combination – showed superior outcome as primary surgical approach. Conclusions: There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage–injection–pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). Methods: This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. Results: The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage–injection–pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. Conclusion: Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB. [ABSTRACT FROM AUTHOR]

. Purpose: To compare the anatomic success between repair of rhegmatogenous retinal detachment (RRD) with superior breaks and repair of RRD with inferior breaks, by performing primary vitrectomy and using similar techniques and the same gas. Methods: Eighty-two consecutive eyes of 80 patients with RRD were included in this retrospective comparative study. The eyes were divided into two groups according to the location of the breaks: superior ( n = 62) and inferior ( n = 20). All the patients underwent a standard, 3-port, 20-gauge pars plana vitrectomy with 20% sulphur hexafluoride gas tamponade performed by the same surgeon. The main outcome measured was the primary anatomic reattachment at 3 months after surgery. Results: The primary anatomic success rate in the inferior group was significantly lower than that in the superior group (80% versus 98%, p = 0.012). In the inferior group, the primary anatomic success rate in patients whose symptoms lasted for more than 2 weeks was significantly lower than that in others (5/9 versus 11/11, p = 0.026). Multivariate logistic regression analysis identified inferior break as the only independent risk factor for redetachment (odds ratio, 11.88; p = 0.034). Conclusion: The anatomic success of primary vitrectomy for RRD with inferior breaks is lower than that for RRD with superior breaks. In particular, the duration of symptoms longer than 2 weeks is associated with a worse outcome in patients who had RRD with inferior breaks. [ABSTRACT FROM AUTHOR]

Purpose To compare pars plana vitrectomy and 360° endolaser therapy with pars plana vitrectomy and an encircling scleral buckle for the treatment of primary rhegmatogenous retinal detachments in a randomized pilot study including 60 patients. Methods Main outcome measures were single-surgery anatomic success rate and final best-corrected visual acuity at 6 months follow-up. Cofactors analysed were complication rates, patients' comfort, refractive outcome and macula status assessed using a spectral-domain optical coherence tomography. Results With differences between both treatment groups regarding type of the retinal detachment, localization of retinal tears (p = 0.0085) and the choice of the intraocular tamponade (p < 0.0202), there were no significant differences between the single-surgery anatomic success rate (93.33% both groups, p = 1.0) and the visual acuity at final follow-up (≤0.3 logMAR [logarithm of minimum angle of resolution] in 66.67% in the endolaser group versus 40.0% in the scleral buckle group, p = 0.0514). Questionnaire responses showed lower levels of patients' discomfort in the endolaser group. A significant difference between both groups was found in the refractive error change after surgery (−0.20 ± 0.51 dioptres in the endolaser group versus −0.88 ± 0.88 dioptres in the scleral buckle group, p = 0.0003). Conclusion Primary vitrectomy combined with 360° endolaser therapy seems to be as effective as vitrectomy combined with an encircling scleral buckle in patients with rhegmatogenous retinal detachment, with possible benefits of an improved patients' comfort and a more stable refractive status after surgery. [ABSTRACT FROM AUTHOR]

Purpose The aim of the study was to evaluate the anatomical success of surgical management of primary rhegmatogenous retinal detachment ( RRD) and to compare the anatomical outcomes from different surgical techniques. Methods During 2012, 517 consecutive eyes (514 patients) were operated by 11 surgeons at the Department of Ophthalmology, Oslo University Hospital. Patient records were retrospectively analysed with no exclusions. Main outcome measures were primary and final anatomical success. Primary anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations excluded. Final anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations included. Results Incidence of RRD was 18.6 eyes per 100 000 person-years. The macula was detached in 50.5% of the eyes at baseline. Of 517 operated eyes, 317 (61.3%) underwent pars plana vitrectomy ( PPV), 23 (4.5%) pars plana vitrectomy together with a scleral buckle ( PPV- SB), 175 (33.9%) scleral buckle ( SB) surgery and two (0.4%) pneumatic retinopexy ( PR). Primary anatomical success was 89.0% in the PPV group, 87.0% in the PPV- SB group and 85.7% in the SB group. Final anatomical success was 98.1% in the PPV group, 100% in the PPV- SB group and 99.4% in the SB group. Factors which were correlated to the redetachment were detachment of more than 6 clock hours (p = 0.003) and visual acuity ( VA) on Snellen chart <0.5 (p = 0.02) at baseline. Conclusion This study showed no significant differences in the surgical success rates in the treatment of RRD between pars plana vitrectomy, scleral buckle or the combined procedure of vitrectomy and buckle. Factors which were found to be correlated to the redetachment of the retina were large detachment and low VA. [ABSTRACT FROM AUTHOR]

Purpose The initial success of vitreoretinal surgery can be annihilated by an acceleration of preexisting glaucoma or the development of secondary glaucoma. Aim of this study was to determine the incidence of and risk factors for medically uncontrollable glaucoma after vitreoretinal surgery. Methods Case-control study amongst patients who underwent vitreoretinal surgery at the University Medical Center Groningen between 1991 and 2011 (in total 14 942 interventions). Cases were all patients who received a glaucoma drainage device after vitreoretinal surgery. Controls were a subset of the patients who underwent vitreoretinal surgery without a subsequent drainage device. Cases and controls were matched (three controls per case) with regard to the year of the (first) vitreoretinal intervention. The incidence rate was calculated from the number of cases and the number of person-years corresponding to all vitreoretinal interventions performed in the study period. Risk factors were analysed with logistic regression. Results Ninety-five cases were identified after a follow-up of 101 961 person-years (one per 1000 person-years). Cases were younger (p = 0.017), were more often men (p = 0.035), underwent more interventions (p < 0.001) or were treated with silicone oil (p = 0.021), had a higher intra-ocular pressure 1 week after the intervention (p < 0.001) and had more often a history of glaucoma or ocular hypertension (p < 0.001). Conclusion Glaucoma after vitreoretinal surgery that requires a glaucoma drainage device is not very common and patients who need a device differ from those who do not. This gives the opportunity to monitor certain subgroups more closely. [ABSTRACT FROM AUTHOR]