Scleral Buckling has no advantage over Pars Plana Vitrectomy in Primary Rhegmatogenous Retinal Detachment Repair: Study

Rhegmatogenous retinal detachment (RRD) can cause significant and irreversible vision loss if left untreated. Recent literature shows an increased incidence of RRD due to increased myopia and cataract surgeries in younger individuals. Pars plana vitrectomy (PPV) is now the preferred primary surgical technique for RRD repair, with supplemental scleral buckling (SB) used in specific cases to address specific complications. Despite its advantages, SB may increase discomfort, altered refractive errors, and controversial benefits. Hence, to address this, researchers from Chiang Mai University Hospital conducted a study to compare anatomical and visual outcomes of PPV alone versus combined PPV/SB using propensity score analysis to reduce bias.

A single center retrospective observational study was carried out y including patients who underwent PPV or PPV/SB for RRD repair between January 2013 and December 2019 and were followed up for at least two months. Demographic data, clinical features, surgeries, and outcome data were collected. Th primary outcomes included the single surgery anatomic success (SSAS) and final anatomic success, whereas the secondary outcomes included final visual acuity changes. Categorization was done based on the retinal breaks and surgeon experience, and visual acuity was converted to LogMAR for analysis. Surgical techniques followed standard PPV protocols, with SB added in specific cases.

Findings:

• About 683 patient-eyes, with a median follow-up duration of 13 months were included in the study.
• Among these 211 patients (30.9%) underwent PPV/SB, while 472 patients (69.1%) underwent PPV as the primary procedure.
• There was no significant difference between the two treatment groups in the risk of achieving SSAS or achieving final retinal anatomic attachment.
• The two treatment groups have shown a similar occurrence of proliferative vitreoretinopathy.
• However, a significantly greater mean improvement in VA was seen in patients who received PPV alone.

Thus, the study concluded that adding SB to PPV had little impact on anatomical results. There was minimal effect on single surgical success rate and overall final success rate. Even though there was an improvement in vision outcomes, the evidence was not definitive. Researchers also suggested further research through prospective studies and using standardized techniques to improve the reliability of the results.

Further reading: Rajsirisongsri, P., Patikulsila, D.et al. Primary Rhegmatogenous Retinal Detachment Repair by Pars Plana Vitrectomy with and without Scleral Buckling: A Propensity Score Analysis. Clinical Ophthalmology, 18, 3913–3923. https://doi.org/10.2147/OPTH.S494849.