Anatomic and Visual Outcomes of Scleral Buckling versus Primary Vitrectomy in Pseudophakic and Aphakic Retinal Detachment Six-Month Follow-up Results of a Single Operation— Report No. 1 Hamid Ahmadieh, MD, 1 Siamak Moradian, MD, 1 Hooshang Faghihi, MD, 2 Mohammad M. Parvaresh, MD, 3 Heshmatollah Ghanbari, MD, 4 Morsal Mehryar, MD, 5 Ebadollah Heidari, MD, 6 Hasan Behboudi, MD, 7 Touka Banaee, MD, 8 Banafsheh Golestan, PhD, 1 for the Pseudophakic and Aphakic Retinal Detachment (PARD) Study Group* Purpose: To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment. Design: Prospective, randomized, multicenter clinical trial. Participants: Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment. Intervention: Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle. Main Outcome Measures: Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia. Results: There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73–2.24), indicating no statistically significant difference. Prolifer- ative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications. Conclusions: Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation. Ophthalmology 2005;112:1421–1429 © 2005 by the American Academy of Ophthalmology. Approximately 30% to 40% of rhegmatogenous retinal de- tachments (RDs) occur after cataract surgery. 1,2 Scleral buckling is a standard surgical method to manage RD after cataract surgery. Nevertheless, the outcomes of scleral buckling in aphakic and pseudophakic eyes generally are Originally received: September 7, 2004. Accepted: February 11, 2005. Manuscript no. 2004-83. 1 Ophthalmic Research Center, Labbafinejad Medical Center, Tehran, Iran. 2 Farabi Eye Hospital, Tehran, Iran. 3 Rasoul Akram Hospital, Tehran, Iran. 4 Feiz Hospital, Esfahan, Iran. 5 Khalili Eye Hospital, Shiraz, Iran. 6 Nikoukari Hospital, Tabriz, Iran. 7 Amiralmomenin Hospital, Rasht, Iran. 8 Emam Reza Hospital, Mashad, Iran. Presented at: American Academy of Ophthalmology Annual Meeting, November, 2003; Anaheim, California. Supported by the National Research Center of Medical Sciences, Tehran, Iran, and the Ophthalmic Research Center of Shaheed Beheshti University of Medical Sciences, Tehran, Iran. None of the authors have a financial interest in the subject matter of the article. Correspondence to Hamid Ahmadieh, MD, Ophthalmic Research Center, Labbafinejad Medical Center, Pasdaran Ave. Boostan 9 St., Tehran 16666, Iran. E-mail: hahmadieh@hotmail.com. *For Study Group membership, see “Appendix.” 1421.e1 © 2005 by the American Academy of Ophthalmology ISSN 0161-6420/05/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2005.02.018