For managing rhegmatogenous retinal detachment (RRD) in eyes with an optically empty vitreous, scleral buckle (SB) alone may yield better anatomical and visual outcomes than pars plana vitrectomy (PPV) or a combined PPV-SB procedure.
This retrospective cohort study compared the surgical outcomes of initial RRD repair using scleral buckle alone (27 eyes) vs pars plana vitrectomy (4 eyes) or combined PPV-SB (25 eyes) in a total of 49 patients with RRD associated with an optically clear vitreous. Forty-three eyes (77%) had Stickler syndrome. All patients were treated by a single surgeon. The outcomes of prophylactic 360-degree laser were also assessed in 60 eyes (48 patients).
Eighty-five percent of patients who underwent SB achieved final anatomical success vs 45% of patients in the combined PPV-SB/PPV group. Patients who had initial SB surgery also showed better final BCVA (0.85 logMAR, BCVA 20/140) than patients who had initial PPV-SB or PPV (1.71 logMAR, BCVA 20/1025). Among the 60 eyes that underwent laser prophylaxis, 10 eyes (17%) experienced a post-prophylaxis retinal tear (range: 70–2382 days), and 6 eyes experienced a post-prophylaxis retinal detachment (range: 70–2314 days).
There are inherent limitations to retrospective studies. This study also involved a relatively small sample size and only evaluated patients at a single institution.
Scleral buckle is a good initial approach for patients with optically empty vitreous and retinal detachments. Prophylactic laser in eyes with optically empty vitreous can decrease the risk of pathology, and patients require continued monitoring.
Financial Disclosures: Dr. Ajay Kuriyan discloses financial relationships with 4DMT, Adverum, Annexon, National Eye Institute, Novartis, Alcon Pharmaceuticals (Grant Support); Alimera Sciences, Allergan, Bausch + Lomb, EyePoint Pharmaceuticals (Consultant/Advisor); Iveric Bio, Optos (Lecture Fees/Speakers Bureau); Lumata Health, Recens Medical (Consultant/Advisor, Private Equity/Stock Holder); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).