Primary Repair of Non-complex Rhegmatogenous Retinal Detachment: Data from Literature and Critical Decision-making Algorithm

To review the available data regarding the current management of non-complex rhegmatogenous retinal detachment and to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment, this study performed. An online review of Pubmed database was performed, searching for all available manuscripts regarding anatomical and functional outcomes after the surgical management of retinal detachment either by scleral buckle or primary pars plana vitrectomy. The search was limited to articles published since 1995 to date. All returned articles were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data which were associated with the surgical outcomes. After categorizing the available data according of their level of evidence; being randomized clinical trial the highest possible level of evidence, followed by retrospective studies and finally retrospective case series as the lowest level of evidence; we proceeded to design a logical decision-making algorithm, enhanced with our experience as retina surgeons. A total of 7 randomized clinical trials, 19 retrospective studies and 9 case series were considered. Additional articles were also included in order to further support the observations. Rhegmatogenous retinal detachment is a potential blinding disorder. Its surgical management seems to depend more on surgeon´s preference than solid scientific data or good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach while improving both anatomical and functional outcomes after the first surgery.