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  • Scleral buckle or not, PPV yields similar results for adult GRT retinal detachments

    Retina/Vitreous

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    Review of: Vitrectomy versus vitrectomy with scleral buckling in the treatment of giant retinal tear related retinal detachments

    Ong S, Ahmed I, Gonzales A, et al. Ophthalmology Retina, July 2022

    The benefit of scleral buckle (SB) in treating giant-retinal tear–associated (GRT) retinal detachment is unclear. As pars plana vitrectomy (PPV) gains popularity, foregoing SB under local anesthesia means circumventing pain for the patient and high stress for the surgeon. This study attempts to determine if scleral buckle brings about an added benefit, either anatomical or in terms of vision outcome.

    Study design

    This is an international multicenter retrospective cohort study analyzing 200 eyes that were surgically treated with PPV vs combined with scleral buckle (PPV/SB). The overall single surgery anatomic success (SSAS) at 6 months and 1 year was determined. Complication rates and visual acuity outcomes also were also studied.

    Outcomes

    Of the 200 eyes included in the study, 101 eyes underwent PPV and 99 underwent PPV/SB. Baseline demographics were equivalent between the 2 groups. The overall SSAS for adults at 6 months (82.2% for PPV alone and 87.9% for PPV/SB) and 1 year (77.2% for PPV alone and 85.7% for PPV/SB) were not statistically different between the 2 cohorts. Visual outcomes also were similar for the adults in each cohort. However, for children, the 1-year SSAS was higher for PPV/SB (88.5%) vs PPV (56.3%). The postoperative complications were similar between the 2 groups.

    Limitations

    Interpretation of the data was hampered by the limitations inherent in retrospective studies. Also, because this was a multicenter international study, surgical techniques were not standardized. The way refraction was performed at the end of 6 months and 1 year was not based on consensus, which limits the interpretation of the BCVA results.

    Clinical significance

    This study demonstrates that managing GRT retinal detachment with either PPV or PPV/SB results in similar SSAS, visual acuity, and complication rate in adults. However, in the pediatric population (children <18 years old), the 1-year SSAS was higher for PPV/SB vs PPV alone.