Surgical Approaches to Pediatric Rhegmatogenous Retinal Detachment Comparable

Both pars plana vitrectomy (PPV) and combined pars plana vitrectomy with scleral buckle (PPV-SB) demonstrate comparable results in terms of anatomical success and postoperative complications in pediatric rhegmatogenous retinal detachment (RRD) repair, according to research published in Clinical Ophthalmology. 

Researchers conducted a retrospective analysis of all patients who underwent RRD repair between 2014 and 2018 at a specialist eye hospital in Saudi Arabia. Participants were younger than 18, underwent primary RRD repair, and had a minimum 12-month follow-up period. 

The cohort included 122 eyes from 117 patients. Eighty eyes of 77 patients underwent PPV alone, while 42 eyes from 40 patients underwent PPV-SB. Mean follow-up periods were 19.2±11 months and 18±12 months in each group, respectively, with a mean patent age of 10.2±5.3 and 10.9±4.8 years. 

Primary cause of detachment in both groups was trauma (45% vs 33.3% of patients in each group), followed by postsurgical outcomes, high myopia, syndromic detachment, and spontaneous detachment. More than 70% of eyes in the PPV group experienced acute-onset RRD (72.5%), compared with 26.2% of eyes in the PPV-SB group. No statistically significant difference between groups was noted in terms of the number of breaks, number of involved quadrants, rates of retinectomy, intentional retinotomy, and tamponade agents used. 

Single surgery success rates were 76.3% and 66.7% in the PPV and PPV-SB groups, respectively. Thirty-three cases were not successful following the first surgery; 9 of these had incomplete vitreous separation. No significant differences in single surgery success rate between the 2 groups was noted. 

Following a second surgery, success rates were 93.8% and 92.7% in the PPV and PPV-SB groups. 

Researchers were able to measure preoperative visual acuity in 82.5% of patients in each group. In the PPV group, 20% of patients had visual acuity better than 20/200, which increased to 33.8% at the final follow-up. Within the PPV-SB group, 9.5% of patients had 20/200 or better visual acuity, which increased to 40.5% at the last follow-up. 

Overall rate of postoperative complications at 6 months was 37%; this rate was slightly higher in the PPV-SB group vs the PPV group (42.9% vs 33.8%). At the final follow-up visit (mean of 2 years±11 months), the rate was nearly equal in both groups (31% vs 32.5%, respectively). 

Study limitations include those inherent to retrospective research and an imbalance in baseline characteristics. 

“[Both] PPV and PPV-SB have comparable results in regard to anatomical success and rate of postoperative complications despite the fact that complicated cases were more [common] in the PPV-SB group, which highlights that there might be a perceived value of scleral buckle with PPV among surgeons in our cohort in complex pediatric RRDs,” according to researchers. 

Reference

Al Taisan AA, Alshamrani AA, AlZahrani AT, AL-Abdullah AA. Pars plana vitrectomy vs combined pars plana vitrectomy-scleral buckle for primary repair of pediatrics retinal detachment. Clin Ophthalmol. 2021;15(5):1949-1955. doi:10.2147/OPTH.S305910