Smoking Linked to Failure of Scleral Buckle for Retinal Detachment Repair

Ophthalmology surgery, Pasteur 2 Hospital, Nice, France, treatment of a retinal detachment through vitrectomy, The doctor is helped by the intern. (Photo by: BSIP/Universal Images Group via Getty Images)
Preoperative vitreous hemorrhaging was also associated with unsuccessful surgeries.

Proliferative vitreoretinopathy (PVR)-associated surgical failure in primary scleral buckling is more likely in patients with a history of smoking and in eyes with preoperative vitreous hemorrhage, according to a study published in Retina. 

Researchers conducted a retrospective, comparison cohort study using billing records data between January and 2015 and December 2018 to determine the rate of PVR formation following primary scleral buckle surgery for rhegmatogenous retinal detachment (RRD) and to identify risk factors. The investigators also compared the eyes with PVR-associated surgical failure and non-PVR associated failure.

The primary study outcome was single-surgery anatomic success after scleral buckle alone for primary RRD. Investigators defined surgical failure as the need for additional retinal detachment repair, such as pneumatic retinopexy, scleral buckle revision, or pars plana vitrectomy (PPV) following initial surgery. Patients within the surgical failure group were divided into subgroups based on whether the surgical failure was or was not associated with PVR. 

The cohort included 530 eyes that underwent primary scleral buckle for RRD, of which 69 had anatomic failure. 

Of the 69 eyes with anatomic failure, 39% and 61% had PVR-associated and non-PVR associated failure, respectively. Those with PVR-associated failure were more likely to be either current or former smokers, to have delayed presentation after initial symptoms, and to have preoperative vitreous hemorrhage before the initial surgery. Between these subgroups, the study identified no differences in RRD size or the number of preoperative retinal breaks. 

Results of a multivariate logistic regression model demonstrated that the odds of PVR-associated failure were higher in patients with a prior history of smoking (OR 28.8), the presence of preoperative vitreous hemorrhage (OR, 8.2), and the presence of preoperative PVR (22.7).

Forty-six percent of patients required 1 additional surgical intervention, while 53% required 2 or more. For the first intervention, 1 patient had pneumatic retinopexy, 1 had scleral buckle revision, and 67 underwent PPV. All eyes that required a second intervention underwent PPV. At the final follow-up, 94% of patients had successful anatomic reattachment without tamponade, while 6% required persistent silicone oil tamponade (4 patients, 2 from each failure group). 

Study limitations include those inherent to retrospective research, the collection of data from a single center, and the inclusion of surgeons with differing preferences and techniques. Selection bias may have also been possible as all eyes were chosen for repair with primary scleral buckle. 

“We observed an overall surgical failure rate of 13% after primary [scleral buckle] for RRD repair, with 5% of failures due to PVR formation,” the researchers concluded. “Further research with prospective, larger patient series will help further refine the risk factors for PVR after primary [scleral buckle], helping to guide patient and surgeon expectations and advise surgical planning.” 

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. 


Patel SN, Salabati M, Mahmoudzadeh R, et al. Surgical failures after primary scleral buckling for rhematogenous retinal detachment: comparison of eyes with and without proliferative vitreoretinopathy. Retina. Published online May 10, 2021. doi:10.1097/IAE.0000000000003214