Retinal Displacement Occurs Less Frequently With Scleral Buckle Than Vitrectomy

Retinal displacement is less common with patients who undergo scleral buckle (SB) alone, without external drainage, as compared with pars plana vitrectomy combined with scleral buckle (PPV–SB), according to a report published in Ophthalmology Retina. Researchers say the SB alone approach may set up better retinal attachment integrity, lowering the chance for retinal displacement after rhegmatogenous retinal detachment (RRD) repair.

The prospective investigation took place at 3 vitreoretinal centers in the US, India, and Canada. Researchers compared retinal displacement risk in 91 adults with fovea-involving RRD; 42 who underwent SB (mean age, 42±14.73 years; 34 men) and 49 who received PPV–SB (mean age, 65.59±9.68 years; 31 men) between July 2019 and February 2022. Masked investigators graded fundus autofluorescence (FAF) images after 3 months.

The reserachers report that 26 participants developed retinal displacement or low-integrity retinal attachment (LIRA); 7 of whom received SB and 19 with PPV–SB, a difference of 22.1% (OR=3.2, 95% CI=1.2 to 8.6, P =.02). Multivariate regression analysis adjusted for baseline logMAR, extent of detachment, lens status, and sex, but the result was a stronger association (P =.01). Further, 22.5% of the SB group who had external subretinal fluid drainage exhibited retinal displacement vs 6.7% of those without drainage (P =.19).

Aniseikonia compared similarly between groups, but individuals with retinal displacement tended to have more horizontal metamorphopsia (P =.067).

“In SB cases with external drainage, the stretched retina may get fixed in position when the drainage comes to a stop and the retina adheres to the RPE in the bed of the buckle,” according to the researchers.

Several prior studies found no retinal displacement after SB, although in 2 analyses, displacement occurred in 1 eye per cohort — and of the pair, 1 was thought unrelated to procedure type. Current investigators hypothesize iatrogenic fluid flow can occur postoperatively with shifts in head position when the “buoyant force” of a large gas bubble displaces some remaining subretinal fluid under the thin retina.

The present study is limited by age difference of the groups, as younger individuals more frequently require SB alone. Also, there was insufficient power to evaluate LIRA risk between patients receiving SB with external drainage vs those without. Conversely, strengths are the multi-center, prospective design, and use of confocal scanning laser ophthalmoscopy FAF.