No Visual Acuity Benefit to Adding Scleral Buckle to Pars Plana Vitrectomy

Whether patients with rhegmatogenous retinal detachment (RRD) undergo pars plana vitrectomy (PPV) alone, or if the surgery is combined with a supplemental scleral buckle (PPV-SB), they have similar visual acuity outcomes, according to a study published in Ophthalmology Retina. However, the researchers report that PPV-SB has superior single-operation success rates. 

Investigators conducted a systematic review and meta-analysis of databases through June 2021 for studies of outcomes from PPV and PPV-SB repair of RRD. This analysis included 15,661 eyes from 38 studies.

The patient cohorts ranged in average age between 27 and 66 years. The baseline best-corrected visual acuity (BCVA) of eyes ranged between 0.28 and 2.34 logMAR. Approximately twice as many eyes received PPV (n=10,397) as PPV-SB (n=5264).

At 6 months after the procedure, researchers noted no significant group difference in BCVA was observed (weighted mean difference [WMD], −0.03; 95% CI, −0.20 to 0.14; P =.75; I², 92%), similar to the final follow-up (WMD, −0.03; 95% CI, −0.14 to 0.07; P =.55).

For surgical outcomes, the single operation success rate was superior for PPV-SB (risk ratio [RR], 0.97; 95% CI, 0.95-1.00; P =.03) and PPV was associated with a higher number of operations to achieve final anatomical reattachment (WMD, 0.13; 95% CI, 0.02-0.24; P =.02). There was no group difference for the final reattachment rate (RR, 1.00; 95% CI, 0.99-1.01; P =.56).

Most adverse event rates were similar between cohorts with the exception of epiretinal membrane (RR, 0.70; 95% CI, 0.52-0.94; P =.02) and macular edema (RR, 0.47; 95% CI, 0.25-0.88) rates, favoring PPV over PPV-SB.

A subgroup analysis of phakic eyes and macular status did not find group differences including for the rate of single operation success. Other subgroups had similar trends as the main analysis.

This study found that most domains for studies had a low risk for bias, however, this analysis was limited by the inconsistencies in reported outcomes across studies.

The study authors concluded that although the single operation success rate of PPV-SB for the repair of RRD was superior to standalone PPV, the final reattachment success rate and visual outcomes did not differ between approaches.

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Eshtiaghi A, Dhoot AS, Mihalache A, et al. Pars plana vitrectomy with and without supplemental scleral buckle for the repair of rhegmatogenous retinal detachment: a meta-analysis. Ophthalmol Retina. Published online February 26, 2022. doi:10.1016/j.oret.2022.02.009