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  • Comparison of Repair Strategies for Moderately Complex RRD

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

    Ophthalmology, August 2020

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    Which surgical strategy is best for repairing moderately complex rheg­matogenous retinal detachments (RRDs)? Ryan et al. com­pared the visual and ana­tomic outcomes for patients with moderately complex RRD who were treated by scleral buckle (SB), pars pla­na vitrectomy (PPV), or the combination of PPV and SB. All three methods delivered good clinical outcomes. SB was superior to PPV in ana­tomic and visual outcomes, and the best anatomic results were achieved with the com­bination procedure.

    For this retrospective study, data were derived from the phakic patient subset of the Primary Retinal Detach­ment Outcomes Study, gathered in 2015 from five large health care centers with strong expertise in all three retinal attachment procedures. The primary outcome was single-surgery anatomic success (SSAS), defined as attainment of retinal attachment without need for a follow-up procedure within 90 days. Another outcome of interest was final visual acuity (VA) following each procedure.

    The final analysis set included 715 phakic patients. Among them, SSAS was achieved in 155 of 169 (91.7%) SB cases, 207 of 249 (83.1%) PPV cases, and 271 of 297 (91.2%) PPV/SB cases. SB and PPV/SB were superior to PPV for achieving SSAS (p = .0041). SB produced better final VA outcomes (p =.0089) than did PPV or PPV/SB, even in patients whose cataract grade was 3+ or higher. SB also showed superior visual outcomes in macula-on and macula-split cases.

    The authors affirmed the lim­itations of their study, including lack of randomization, imbalance of baseline traits among treatment groups, and nonstandardization of VA measure­ments. Future studies are needed to control for confounding variables, said the au­thors. Regardless, their data show the continued value of SB in the treatment of moderately complex phakic RRD and, as a result, the need for this tech­nique to be an essential component of fellowship training.

    The original article can be found here.