APR 21, 2020
This large, multicenter, retrospective cohort study compared scleral buckle and pars plana vitrectomy for moderately complex phakic primary rhegmatogenous retinal detachment (RRDs).
Patients underwent pars plana vitrectomy (n=249 cases), scleral buckle (n=169 cases) or scleral buckle with vitrectomy (PPV/SB; n=297 cases) and were followed for 90 days or more. Procedures were performed by 61 surgeons at 5 large retinal groups in 2015. The main outcome measure was single-surgery anatomic success, defined as retinal attachment with no other RRD surgery within 90 days.
Single-surgery anatomic success occurred in 83% of vitrectomy cases, 92% of scleral buckle cases and 91% of cases receiving both treatments. Both scleral buckle and the combination treatment were superior to vitrectomy in achieving single-surgery anatomic success (P=0.004). After controlling for preoperative macular status, individuals who underwent scleral buckle exhibited significantly better visual outcomes than those in the other 2 groups (P=0.009).
The limitations of this study are those usual for a retrospective study, such as treatment bias based on surgeon preferences and data variation between different surgeons and institutions. Not all baseline characteristics were balanced across the 3 treatment groups and vision measurement was not standardized.
These findings suggests that scleral buckling may have advantages over primary vitrectomy for phakic, moderately complex detachments. Although all 3 surgical modalities in the study had good clinical outcomes, vitrectomy was inferior to scleral buckling in both anatomic and visual outcomes and inferior to combined treatment in anatomic outcomes. It is therefore important that surgeons continue to be educated on how to perform scleral buckling.