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  • Anatomic Outcomes for PPV and PPV Plus Scleral Buckle

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2020

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    During the past 15 years, the standard of care for rhegmatogenous retinal detachment (RRD) has shifted from scleral buckle (SB) to pars plana vitrectomy (PPV). However, despite this trend, researchers have conduct­ed few comparisons of PPV and the combination of PPV and SB (PPV-SB) across multiple sites and with multiple surgeons. To address this gap, Joseph et al. performed a multicenter study and found that, relative to PPV alone, the PPV-SB combination produced superior single-surgery anatomic suc­cess. Visual acuity (VA) outcomes were similar for the two cohorts.

    This retrospective study included six retina practices and 61 surgeons. Only patients with at least 90 days of follow-up were considered. Among the 893 pseudophakic eyes that met inclu­sion criteria, 23% received the PPV-SB combination, and 77% had PPV alone. Collected data included macula status; RRD location; and the size, type, and number of retinal breaks. Main out­comes were VA and anatomic success; the latter was defined as retinal attach­ment without ongoing tamponade or another RRD surgery within 90 days of primary repair.

    Anatomic success was achieved in 84% of vitrectomy-only cases and in 92% of combination procedures (p = .0093). Post-op VA outcomes did not differ substantially between the two study groups (p = .8581). Anatomic success was not affected by the type of gas tamponade or the gauge of in­strumentation. Although PPV-SB was performed in more eyes with infe­rior detachments, the buckle addition seemed beneficial for RRDs of vari­ous anatomic configurations. In both macula-on and macula-off eyes, as well as inferior and superior detachments, PPV-SB outperformed PPV with re­spect to anatomic success.

    The superior anatomic success of PPV-SB in this study may relate to the buckle’s ability to close small tears that could have been missed other­wise, the authors said. However, they also acknowledged the possibility of chance, given the study’s retrospective nature. Adding the buckle to all PPVs for RRD would not necessarily improve anatomic success, they said. “To prove cause and effect, we need a randomized controlled prospective study powered to test this hypothesis.”

    The original article can be found here.