Scleral buckling may offer benefits in treatment of rhegmatogenous retinal detachment, suggests research
Researchers found that even though, over the past few years, the repair of rhegmatogenous retinal detachment (RRD) using scleral buckling was performed less often, in certain patient groups this method still remains important. In recent comparative studies researchers concluded that scleral buckling produces better outcomes, especially in younger phakic patients and children. This study was conducted by Wang K. and colleagues and was published in the journal Current Opinion in Ophthalmology.
Several key new findings from the recent literature favor continuing the role of scleral buckling in repair of RRD:
• Primary scleral buckling is shown to provide superior visual and anatomic results in more youthful, phakic patients compared with pars plana vitrectomy (PPV).
• Children are primarily treated with scleral buckling because it produces excellent results in them.
• The lesser rate of retinal displacement is one functional advantage of scleral buckling compared to PPV.
• Less frequent retinal displacement and, thereby, less frequent visual distortion and suboptimal outcome are significant facts adding to the importance of this technique in certain cases.
• The addition of scleral buckling may be advantageous in many patients who need PPV. However, the notion that a combination of these procedures would serve to some advantage in clinical situations is untested and thus is worthy of further investigation.
Scleral buckling is a surgical technique first described by Thomas and Scott as suturing a silicone band to indent the sclera and thereby close retinal tears, providing support to the reattachment process of the retina. Traditionally, this technique was highly frequently used for RRD repair even before PPV became widely used. This is primarily due to the fact that the latter has become more popular, especially after advancements in surgical instruments and techniques. However, despite the increased usage of PPV nowadays, scleral buckling still offers several crucial advantages especially in patients with certain risks, such as younger age, phakic status, or specific retinal configurations.
Scleral buckling remains a preferred initial surgical approach in children with RRD because a good anatomical reattachment with fewer complications is achieved. Children's eyes often respond positively to the less invasive nature of scleral buckling compared to PPV that the vitreous gel removed from the eye. Thus, scleral buckling remains an important role in children.
Scleral buckling remains an important technique in the treatment of rhegmatogenous retinal detachment for the younger, phakic patient and for children. Although PPV has become increasingly used, scleral buckling is still the better method for obtaining visual and anatomic outcomes in specific patient groups; besides, it induces significantly lower retinal displacement. Training surgeons in this method is crucial for optimal results with retinal detachment. Future research will help clarify the optimal use of scleral buckling, both in isolation and in combination with PPV.
Reference:
Wang, K. Y., Adams, O. E., Yu, M. D., & Yonekawa, Y. (2024). The necessity and role of scleral buckling for rhegmatogenous retinal detachment. Current Opinion in Ophthalmology, 35(5), 376–381. https://doi.org/10.1097/icu.0000000000001065
