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Scleral buckling versus pars plana vitrectomy in simple phakic macula-on retinal detachment: a propensity score-matched, registry-based study
  1. Sumihiro Kawano1,
  2. Takumi Imai2,
  3. Taiji Sakamoto3
  4. the Japan-Retinal Detachment Registry Group
    1. 1Ophthalmology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
    2. 2Medical Statistics, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan
    3. 3Ophthalmology, Kagoshima University, Kagoshima, Japan
    1. Correspondence to Dr Taiji Sakamoto, Ophthalmology, Kagoshima University, Kagoshima 890-0065, Japan; tsakamot{at}m3.kufm.kagoshima-u.ac.jp

    Abstract

    Background/Aims To assess the anatomical and visual results of uncomplicated phakic macula-on retinal detachment (RD) in patients treated with pars plana vitrectomy (PPV) or scleral buckling (SB).

    Methods A retrospective cohort of patients aged <65 years and diagnosed with uncomplicated phakic macula-on primary RD, who were registered in the Japan-Retinal Detachment Registry, was compiled between February 2016 and March 2017. We performed propensity score matching using preoperative findings and surgeon-related factors as covariates to account for relevant confounders. The primary outcome was anatomical failures at 6 months postoperatively, classified as follows: level 1, an inoperable state; level 2, anatomical recovery with silicone oil tamponade; and level 3, need for additional surgery to repair the detachments. The secondary outcome was change in best-corrected visual acuity (BCVA).

    Results Of the 822 included patients, 552 underwent PPV and 270 underwent SB. After propensity score matching, 137 matched cases between the PPV and SB groups were analysed. The total proportion of surgical failures in the PPV group was higher than that in the SB group (risk difference, 0.10 (0.02 to 0.18), p=0.011, McNemar’s test). Conversely, the change in BCVA was not significantly different between the two groups (logMAR units, −0.015 (−0.084 to 0.053), p=0.66, paired samples t-test).

    Conclusions Although the indications for PPV are becoming broader, PPV may not be the optimal approach for repairing all types of RD. Therefore, careful consideration is needed when selecting the right surgical technique for treating uncomplicated phakic macula-on RD cases.

    • retina
    • treatment surgery

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    Footnotes

    • Presented at Part of this data was presented at the XXXIth Meeting of the Club Jules Gonin, Jersey, Channel Islands, GB, and the Vail Vitrectomy, Vail, Colorado, USA, 2019.

    • Collaborators We would also like to thank the Institutions of the Japan Retinal Detachment Registry project committee and their collaborators: 1. Chiba University: Shuichi Yamamoto, Takayuki Baba, Eiju Sato, Masayasu Kitahashi, Tomoaki Tatsumi, Gen Miura and Tomohiro Niizawa. Kagoshima University: Taiji Sakamoto, Keita Yamakiri, Toshifumi Yamashita, Hiroki Otsuka, Seiji Sameshima, Narimasa Yoshinaga and Shozo Sonoda. Kyorin University: Akito Hirakata, Takashi Koto, Makoto Inoue, Kazunari Hirota, Yuji Itoh, Tadashi Orihara, Yoshinobu Emoto, Masahiko Sano, Hiroyuki Takahashi and Ryo Tokizawa. Yamagata University: Hidetoshi Yamashita, Koichi Nishitsuka, Yutaka Kaneko and Katsuhiro Nishi. Finally, we would like to thank the following collaborative institutions and collaborators: Asahikawa Medical University Hospital: Akitoshi Yoshida, Shinji Ono, Hiroyuki Hirokawa, Kenji Sogawa, Tsuneaki Omae and Akihiro Ishibazawa. Gunma University: Shoji Kishi, Hideo Akiyama, Hidetaka Matsumoto, Ryo Mukai and Masahiro Morimoto. Hirosaki University: Mitsuru Nakazawa, Yukihiko Suzuki, Takashi Kudo and Kobu Adachi. Hokkaido University: Susumu Ishida, Kousuke Noda, Satoru Kase, Syouhei Mori, Ryo Ando, Michiyuki Saito and Tomohiro Suzuki. Kansai Medical University Hospital: Kanji Takahashi, Yoshimi Nagai, Tadashi Nakauchi and Haruiko Yamada. Kindai University Sakai Hospital: Shuji Kusaka and Daishi Tsujioka. Kyoto University: Akitaka Tsujikawa and Kiyoshi Suzuma. Kyushu University: Tatsuro Ishibashi, Koh-Hei Sonoda, Yasuhiro Ikeda, Riichiro Kohno and Keijiro Ishikawa. Mie University: Mineo Kondo and Maki Kozawa. Nagasaki University: Takashi Kitaoka and Eiko Tsuiki. Nagoya City University: Yuichiro Ogura, Munenori Yoshida, Hiroshi Morita, Aki Kato, Yoshio Hirano and Kazuhiko Sugitani. Nagoya University: Hiroko Terasaki, Takeshi Iwase, Yasuki Ito, Shinji Ueno, Hiroki Kaneko, Norie Nonobe and Taro Kominami. National Center for Child Health and Development: Noriyuki Azuma and Tadashi Yokoi. Nihon University Hospital: Hiroyuki Shimada, Hiroyuki Nakashizuka, Takayuki Hattori, Ari Shinojima and Yorihisa Kutagawa. Okayama University: Fumio Shiraga, Yuki Morizane and Shuhei Kimura. Osaka Medical School: Tsunehiko Ikeda, Teruyo Kida, Takaki Sato and Masanori Fukumoto. Osaka Rosai Hospital: Kazuyuki Emi and Hiroshi Nakashima. Shiga Medical University: Masahito Ohji, Masashi Kakinoki and Osamu Sawada. Takeuchi Eye Clinic: Shinobu Takeuchi and Sumiyoshi Tanaka. Tokyo Womens Medical College: Tomohiro Iida, Hideki Koizumi, Ichiro Maruko, Taiji Hasegawa and Akiko Kogure. Yamanashi University: Hiroyuki Iijima, Tomohiro Oshiro, Yasushi Tateno, Wataru Kikushima, Atsushi Sugiyama and Seigo Yoneyama. Yokohama City University Medical Center: Kazuaki Kadonosono, Shimpei Sato and Shin Yamane.

    • Contributors SK and TI: study design; SK and TS: acquisition, data collection; SK, TI and TS: manuscript preparation; SK, TI and TS: manuscript revision; SK, TI and TS: overall responsibility.

    • Funding This work was supported by JSPS KAKENHI Grant Number JP18H02957.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The main study protocol of the J-RD Registry was approved by the Ethics Committee of Kagoshima University (140093, 28-38), and the registry was compiled in accordance with the tenets of the Declaration of Helsinki, as well as with the Kyushu University Hospital Ethical Committee regulations.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.

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