Materials and Methods

The literature was reviewed from 1972 to 2003 for reports about repair of primary retinal detachment. The database (Medline) was searched with keywords: primary retinal detachment and pneumatic retinopexy, vitrectomy, and buckle. We found a total of 329 trials (Tables 8.1-8.3). Inclusion criteria were that the detachments were uncomplicated; the extension of the detachments, number of breaks, and the age of the detachments were not a factor. Studies were excluded if proliferative vitreoretinopathy (PVR) was greater than a Ci. There were 25 studies enrolling 1,465 patients treated with primary vitrectomy [1-25], 29 studies enrolling 1,919 patients for pneumatic retinopexy [26-54], and 10 studies enrolling 1,854 patients treated with segmental buckles [55-62]. Unsuccessful primary attachment and the presence of PVR postoperatively were

8 Systematic Review of Efficacy and Safety of Surgery

Table 8.1. Pneumatic retinopexy studies

Study

Year

Number of

Second

Proliferative

patients

surgery

vitreoretino-

(total 1919)

(total 484)

pathy (total 111)

Kleinmann [26]

2002

44

20%

7%

Abecia [29]

2000

219

18%

3%

Eter [27]

2000

78

35%

6%

Assi [28]

1999

31

39%

13%

Lisle [30]

1999

36

17%

3%

Han

1998

50

36%

12%

Tornambe [54]

1997

302

32%

10%

Mulvihill [32]

1996

10

10%

n.a.a

Grizzard [33]

1995

107

31%

n.a.a

Gunduz [34]

1994

30

10%

3%

Boeker [35]

1994

133

27%

5%

Sebag [36]

1993

45

13%

2%

Bochow [37]

1992

17

29%

12%

Algvere [44]

1992

51

14%

4%

Berrod [39]

1990

56

34%

16%

Tornambe [31]

1989

103

27%

7%

Termote [40]

1989

20

20%

5%

Lemmen [41]

1989

54

50%

6%

Skoog [42]

1989

50

16%

n. a.a

Lowe [43]

1988

55

18%

n. a.a

Algvere [38]

1988

58

36%

14%

McAllister [45]

1988

56

29%

7%

Chen [46]

1988

51

37%

4%

Hilton [50]

1987

100

16%

6%

Poliner [48]

1987

13

31%

8%

Gnad [49]

1987

27

4%

0%

van Effenterre [24]

1987

60

10%

2%

Hilton [47]

1986

20

10%

5%

Dominguez [51]

1986

43

7%

2%

Weighted average

25.2%

6.5%

a Not available a Not available

Materials and Methods

Table 8.2. Vitrectomy studies

Study

Year

Number of

Second

Proliferative

patients

surgery

vitreoretino-

(total 1465)

(total 196) pathy

(total 76)

Pournaras [2]

2003

51

4%

2%

Tanner [3]

2001

9

11%

n.a.a

Oshima [1]

2000

47

9%

4%

Miki [4]

2000

87

8%

1%

Speicher [5]

2000

78

6%

5%

Pournaras [6]

2000

76

3%

1%

Gastaud [7]

2000

19

16%

n. a.a

Brazitikos [13]

2000

103

6%

4%

Oshima [9]

1999

63

8%

0%

Newman [10]

1999

25

16%

8%

Devenyi [11]

1999

94

0%

0%

Campo [12]

1999

275

12%

6%

Brazitikos [8]

1999

14

0%

0%

Sharma [14]

1998

21

10%

10%

Hoerauf [15]

1998

37

14%

8%

Desai [16]

1997

10

0%

n. a.a

El-Asrar [17]

1997

22

0%

5%

Yang [18]

1997

10

10%

n. a.a

Heimann [19]

1996

53

36%

6%

Bartz-Schmidt [20]

1996

33

6%

3%

Hoing [21]

1995

32

22%

19%

Girard [22]

1995

103

26%

17%

Gartry [23]

1993

114

26%

8%

van Effenterre [24]

1987

60

13%

0%

Escoffery [25]

1985

29

21%

7%

Weighted average

13.3%

5.3%

a Not available a Not available

Table 8.3. Scleral buckle and balloon studies

Study

Year

Number of

Second

Proliferative

patients

surgery

vitreoretino-

(total 1854)

(total 170)

pathy (total 17)

Oshima [1]

2000

55

9%

4%

Green [61]

1996

162

12%

2%

Kreissig [62]

1992

107

7%

4%

Kreissig [56]

1989

500

7%

0%

McAllister [45]

1988

28

36%

7%

Richard [60]

1987

100

6%

n.a.a

Binder [58]

1986

52

4%

n.a.a

Schoch [59]

1986

45

7%

2%

O'Connor [55]

1976

50

0%

0%

Lincoff [57,67]

1972

755

11%

0%

Weighted average

9.1%

0.9%

a Not available a Not available the main outcome measures. Patient and surgical characteristics were mostly homogeneous. The common denominator was that the detachment might have responded to scleral buckling.

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