Background: Upper bullous retinal detachment is surgically challenging. Multiple surgical techniques have been advocated to tackle upper bullous retinal detachment yet there is no consensus in the best surgical approach. This study aims at assessing the effectiveness and safety of scleral buckle compared to chandelier assisted scleral buckle and primary vitrectomy with gas endo tamponade in achieving retinal reattachment in patients with upper bullous detachment.

Methods: sixty-nine eyes with upper bullous detachment were included in this study. They were treated with either Standard Scleral Buckle SSB (Group 1), Chandelier assisted Scleral Buckle CSB (Group 2) or Pars Plana Vitrectomy with gas endo tamponade PPV (Group 3). Pre-operative, intra-operative and post-operative data including best corrected visual acuity, IOP and persistence of sub retinal fluid, intraoperative and post-operative complications were recorded. Patients were followed up for at least 6 months.

Results: There was no statistically significant difference between the three groups regarding successful reattachment rates. The primary success rate was 92.3 % in group 1, 95.7% in group 2 and 82.6 % in group 3 with final success rate of 100% in all groups. However, 10 patients in group 2 had required reoperation either for surgical failure, recurrence or removal of epi macular membrane compared to 6 patients in vitrectomy group and 6 patients in scleral buckle group (P <0.001).

Conclusion: There is no surgical advance of one technique over the other for management of this complex type of detachment. However, CSB may subject patients to secondary interventions to maintain visual outcome.