Outcomes in rhegmatogeneous retinal detachment repair: a propensity-matched cohort analysis

Authors: Mélanie Hébert, Eunice You, Jérôme Garneau, Serge Bourgault, Mathieu Caissie, Éric Tourville, Ali Dirani.

Disclosure Block: M. Hébert: None. E. You: None. J. Garneau: None. S. Bourgault: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Novartis, Bayer. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant, Consultant. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Novartis, Bayer. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Ad-board, Ad-board. M. Caissie: None. É. Tourville: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Novartis, Bayer, Roche. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Novartis, Bayer. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Ad-board. A. Dirani: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Novartis, Bayer. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Ad-board.

Abstract Body:

Purpose: To compare outcomes following rhegmatogeneous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) only or PPV with scleral buckle (PPV-SB).
Study Design: Retrospective, propensity-matched cohort study.
Methods: Between 2014 and 2018, 1548 patients were operated for primary RRD repair at the Centre hospitalier universitaire de Québec - Université Laval using PPV (n=827) or PPV-SB (n=721). Patients with other RD etiologies were excluded, including ≥C1 proliferative vitreoretinopathy (PVR). Choice of procedure was at the surgeon’s discretion. We used a propensity score to obtain a 1:1 nearest-neighbor matching with a caliper of 0.2 accounting for age, sex, laterality, pseudophakia, myopia, macula status, number of detached quadrants and tears, symptoms duration, and visual acuity (VA) at baseline. Patients with missing data were excluded. Therefore, 654 patients undergoing PPV and 593 patients undergoing PPV-SB were considered for matching.
Results: A total of 886 patients were matched between the PPV group (n=439) and the PPV-SB group (n=439). After matching, there were no significant between-group differences in baseline characteristics, tamponade agent used, and follow-up durations. Mean age was 63.3±9.5 years. There were 590 (67%) men, 395 (45%) patients were pseudophakic, and 168 (19%) had myopia greater than 4 diopters. At presentation, patients had symptoms for 12.2±14.7 days and 2.5±0.8 quadrants were affected with 2.1±1.6 retinal tears. Most patients were macula-off (n=506, 57%) and baseline VA in logMAR was 0.93±1.08. Treatment mostly used SF₆ (n=711, 80%) or C₃F₈ (n=160, 18%). Patients were followed for 15.9±16.2 months. There were less recurrences of RRD in the PPV group (PPV: n=30, 7% vs. PPV-SB: n=49, 11%; p=0.025). Subsequent surgeries were required to correct these recurrences (PPV: 0.08±0.33 surgeries vs. PPV-SB: 0.14±0.41; p=0.024). PVR or epiretinal membrane as a cause of recurrence was higher in the PPV-SB group (PPV: n=14, 3% vs. PPV-SB: n=33, 7%; p=0.004). At final follow-up, 1 patient (0.2%) in both groups had a detached retina (p=1.00). VA at 3 months was 0.38±0.45 in the PPV group compared to 0.47±0.56 in the PPV-SB group (p=0.001). At final follow-up, this was 0.28±0.40 in the PPV group compared to 0.36±0.53 in the PPV-SB group (p=0.009).
Conclusions: Following uncomplicated primary RRD repair, there were less recurrences and better VA at follow-up in patients who underwent PPV only compared to PPV-SB. This was found in a homogeneous cohort of simple RRD cases with on average symptoms less than 2 weeks and 2.5 detached quadrants with 2 tears.