Adding Scleral Buckling to Re-Vitrectomy May Provide Similar Recurrent Retinal Detachment Outcomes

Re-vitrectomy alone appears to provide similar anatomical and functional outcomes as combined re-vitrectomy with scleral buckling (SB) for recurrent rhegmatogenous retinal detachment (RRD) after failed primary pars plana vitrectomy (PPV) in pediatric patients, according to research published in Clinical Ophthalmology.

The researchers conducted a retrospective, comparative case series of pediatric patients (<18 years of age) who underwent secondary RRD procedures after failed primary PPV. They divided the patients into 2 groups, a re-vitrectomy group and combined re-vitrectomy with SB group. 

The primary outcome was the anatomical success rate of each recurrent RRD procedure (re-vitrectomy alone vs combined re-vitrectomy with SB), and the secondary outcomes were changes in best-corrected visual acuity (BCVA) and postoperative complications.

A total of 53 eyes of 51 pediatric patients who underwent recurrent RRD repair after failed primary PPV were included in the study. The re-vitrectomy group comprised 30 eyes of 29 patients (mean age, 10.9±3.7 years; 72% boys and 28% girls), and the combined re-vitrectomy with SB group comprised 23 eyes of 22 patients (mean age, 10.3±4.3 years; 68% boys and 32% girls). The mean follow-up duration of the re-vitrectomy group and re-vitrectomy with SB group was 21.7±6.9 months and 26.5±7.7 months, respectively (P =.03).

The researchers observed no statistically significant difference in the final anatomical success rates of the re-vitrectomy group and re-vitrectomy with SB group (83.3% vs 73.9%; P =.41) They also observed no statistically significant difference in the mean change in BCVA (0.62±0.78 vs 0.80±0.97 logMAR; P =.37) or incidence of postoperative complications (70% vs 52.2%; P =.25) between the re-vitrectomy group and re-vitrectomy with SB group. 

“According to our results, re-vitrectomy alone provides similar anatomical and functional outcomes compared to combined re-vitrectomy/SB for pediatric recurrent RRD after failed primary PPV,” researchers report. “Further randomized prospective studies in more patients are needed to compare these 2 procedures for pediatric recurrent RRD.”

Limitations of the study included the retrospective design, a relatively small sample size due to the low incidence of pediatric RRD, potential referral bias, lack of long follow-up durations to evaluate the long-term outcomes, and continued presence of silicone oil in the eyes of many patients at the last follow-up visit.

Reference

Al Abdulsalm O, Al Habboubi H, Mura M, Al-Abdullah A. Re-vitrectomy versus combined re-vitrectomy with scleral buckling for pediatric recurrent retinal detachment. Clin Ophthalmol. 2022;16:877-884. Published online March 22, 2022. doi:10.2147/OPTH.S356993