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      Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis

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          Abstract

          Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis. Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups. Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement ( p < 0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%, p = 0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors. Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

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          Most cited references18

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          Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical consequences.

          During the last four decades, proliferative vitreoretinopathy (PVR) has defied the efforts of many researchers to prevent its occurrence or development. Thus, PVR is still the major complication following retinal detachment (RD) surgery and a bottle-neck for advances in cell therapy that require intraocular surgery. In this review we tried to combine basic and clinical knowledge, as an example of translational research, providing new and practical information for clinicians. PVR was defined as the proliferation of cells after RD. This idea was used for classifying PVR and also for designing experimental models used for testing many drugs, none of which were successful in humans. We summarize current information regarding the pathogenic events that follow any RD because this information may be the key for understanding and treating the earliest stages of PVR. A major focus is made on the intraretinal changes derived mainly from retinal glial cell reactivity. These responses can lead to intraretinal PVR, an entity that has not been clearly recognized. Inflammation is one of the major components of PVR, and we describe new genetic biomarkers that have the potential to predict its development. New treatment approaches are analyzed, especially those directed towards neuroprotection, which can also be useful for preventing visual loss after any RD. We also summarize the results of different surgical techniques and clinical information that is oriented toward the identification of high risk patients. Finally, we provide some recommendations for future classification of PVR and for designing comparable protocols for testing new drugs or techniques.
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            Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1.

            To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs).
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              Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques.

              To compare functional and anatomical outcomes of modern methods of repair of primary retinal detachment. Retrospective interventional comparative case series. A total of 1,226 patients with primary retinal detachment were included in the study. All patients completed 1-year follow-up and were divided into 4 groups: 322 patients underwent scleral buckling surgery, 442 patients underwent pars plana vitrectomy surgery, 316 patients underwent a combination of scleral buckling and vitrectomy surgery, and 56 patients underwent pneumatic retinopexy surgery for the primary repair of retinal detachment. Reattachment success rates, pre- and postoperative visual acuity, complications, and change in refractive error were reviewed. Initial success rate for retinal reattachment was 86% for scleral buckling only, 90% for vitrectomy only, 94% for the combination of scleral buckling and vitrectomy, and 63% for pneumatic retinopexy surgery. Although patients undergoing pneumatic retinopexy had a lower initial success rate, there was no statistically significant difference in initial reattachment rates between the other three groups. There was no statistically significant difference in final visual acuity between the four groups. Complication rates varied among the techniques used. Postoperative visual acuity at 1 year did not differ among the various techniques used to repair primary rhegmatogenous retinal detachments. However, scleral buckling, vitrectomy, or a combination of both resulted in an initially better anatomical success rate and fewer operative procedures than pneumatic retinopexy.
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2016
                5 September 2016
                : 2016
                : 4538193
                Affiliations
                1Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
                2Jeonju Samsung Eye Clinic, Jeonju, Jeonrabuk-do, Republic of Korea
                Author notes
                *Sung Pyo Park: eyepyo@ 123456gmail.com

                Academic Editor: Miguel Cordero-Coma

                Author information
                http://orcid.org/0000-0002-6850-1835
                http://orcid.org/0000-0002-5174-6334
                http://orcid.org/0000-0002-6978-0311
                Article
                10.1155/2016/4538193
                5027318
                27688907
                c8cc6a7a-0359-4793-af2c-09f009f9d600
                Copyright © 2016 Yong-Kyu Kim et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 April 2016
                : 11 August 2016
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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