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Br J Ophthalmol. 2017 Jun;101(6):712-718. doi: 10.1136/bjophthalmol-2016-309240. Epub 2016 Sep 8.

Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2-main results.

Author information

1
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
2
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
3
Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany.
4
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
5
Eye Hospital, Hannover Medical School, Hannover, Germany.
6
Department of Ophthalmology, University of Regensburg, Regensburg, Germany.
7
Department of Ophthalmology, Franziskus Hospital, Münster, Germany.

Abstract

BACKGROUND:

It is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy.

METHODS:

257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months.

RESULTS:

Success was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average -0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of -1.0 D in group E1 compared with -0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1.

CONCLUSIONS:

Vitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique.

TRIAL REGISTRATION NUMBER:

DKRS 00003158, Results.

KEYWORDS:

Retina; Treatment Surgery

PMID:
27609785
PMCID:
PMC5583681
DOI:
10.1136/bjophthalmol-2016-309240
[Indexed for MEDLINE]
Free PMC Article

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