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  • Scleral Buckling Plus PPV for Retinal Detachment Repair

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, February 2021

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    Scleral buckling (SB) plus pars plana vitrectomy (PPV) for repair of rheg­matogenous retinal detachments (RRDs) remains controversial. Echegaray et al. compared the outcomes of primary uncomplicated RRD repair using PPV alone with those achieved via the com­bination of SB and PPV. They found that SB + PPV resulted in greater sin­gle-operation anatomic success (SOAS), particularly among phakic eyes.

    This retrospective observational study of 488 patients (mean age, 59.2 years) was conducted at the Bascom Palmer Eye Institute from June 1, 2014, through Dec. 31, 2017. Patients young­er than age 18 were excluded, as were those with advanced proliferative vitre­oretinopathy, giant retinal tear, trauma, or secondary forms of RRD.

    With regard to preoperative lens status, 288 of the patients (59%) were phakic, 188 (38.5%) had a posterior chamber IOL, and eight (1.6%) were aphakic. The extent of the RRD involved 3 clock hours or more in 447 patients (91.6%), and inferior RRD location was found in 265 patients (54.3%).

    After a mean follow-up of 14.3 months, SOAS (defined as adequate retinal reattachment with only one pro-cedure) and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. SOAS oc­curred in 90 of 111 eyes (81.1%) treated with PPV alone, compared with 345 of 374 eyes (92.2%) that underwent the combined procedure. In addition, in those treated with SB + PPV, greater SOAS occurred in phakic eyes (p < .0001) than in those with a posterior chamber IOL. In addition, SOAS was correlated with greater improvement in best-cor­rected visual acuity.

    A retinal redetachment occurred in 63 patients (12.9%). Of these, 50 were affected within the initial three months following surgery (mean, 1.5 months), while the remaining 13 patients expe­rienced redetachment after the three-month period (mean, 9.3 months). The authors noted that this bimodal distri­bution may inform optimal follow-up regimens.

    The original article can be found here.