Initial Scleral Buckle Yields Superior Outcomes in Rhegmatogenous Retinal Detachment

Initial scleral buckle yields better outcomes compared with initial pars plana vitrectomy (PPV) or initial PPV-scleral buckle in patients with syndromes with optically empty vitreous (SOEV) presenting with rhegmatogenous retinal detachment (RRD), according to a study published in Ophthalmology Retina. Similar surgical approaches may be best for all patients with SOEV associated RRD, the report suggests.    

Researchers conducted a retrospective cross-sectional study of a single pediatric vitreoretinal surgeon’s patients who underwent retinal detachment (RD) repair via PPV, scleral buckle, or PPV-scleral buckle or underwent unilateral/bilateral laser prophylaxis for prevention of RD. The study included 56 eyes from 49 patients in the retinal detachment arm (mean age at retinal detachment presentation, 11.6 years; 37 eyes were male, 19 eyes were female) and 60 eyes from 48 patients in the laser prophylaxis arm (median age of laser prophylaxis, 10 years; 41 eyes were male, 19 eyes were female).

All patients were identified by slit lamp examination (presence of an optically empty or void space in the vitreous gel structure) or genetic testing.

The research team performed a comparison of initial RD surgical repair via PPV, scleral buckle, or PPV-scleral buckle with final anatomic success, best corrected visual acuity (BCVA), and number of surgical procedures. The primary study outcome measures were visual acuity, surgical repair techniques (PPV, scleral buckle, PPV-scleral buckle), number of surgeries and anatomical retinal reattachment success.

The researchers report that initial scleral buckle had statistically significant better final BCVA (P <.01) and better final anatomic success (P <.01). They found no statistical difference in the number of surgeries needed to achieve anatomic success between the initial scleral buckle compared with the initial PPV-scleral buckle/PPV.

Hyaloidal elevation during the initial vitrectomy was associated with achieving better BCVA and higher final anatomic success without needing silicone oil (P <.01 and 0.04, respectively). Eyes who developed RDs following laser prophylaxis had better final BCVA compared with untreated eyes (P =.05).

“No significant difference in the number of surgeries and final retinal reattachment rates were seen between Stickler Type 1 patients and SOEV patients with RRD, suggesting similar approaches should be employed for all SOEV that present with RRD,” according to the researchers. “This study also found laser prophylaxis appear to provide better final visual acuity after surgical repair when a RD develops later in life, however laser prophylaxis did not result in fewer surgeries for RD repair.”

Study limitations include its retrospective nature, single surgeon methodology, single center design, limited sample size, and possibility of selection bias in the RD arm because the initial PPV-scleral buckle may be performed for more advanced proliferative vitreoretinopathy presentations compared with scleral buckle.