Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks

Abstract

Purpose To describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Patients and Methods This is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020. Results A total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period. Conclusion The combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.

Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment

“…Vitrectomy is preferred in cases with complicating factors at the time of presentation, and in eyes with pseudophakic detachment, multiple or posterior retinal breaks, and vitreous opacities. Additionally, multiple studies have demonstrated that the two procedures can be combined to produce superior results in cases of anterior or inferior tears [ 7 , 8 ]. These procedures and their combined approach have been explained in detail in recent reviews by Warren et al [ 9 ] and Sultan et al [ 5 ].…”

Outcomes of Scleral Buckling Surgery in Rhegmatogenous Retinal Detachment: An Iranian Experience

“…In our study, similar to recent reports, inferior retinal detachments were associated with worse anatomical outcomes than non-inferior detachments. Inferior retinal detachments mostly carry a greater risk of recurrence, which may be related to the lack of silicone oil tamponade to the inferior retina, challenging patients posturing, high risk of PVR presence, and missed breaks in the case of vitreous hemorrhage 9 . Heussen et al found that inferior retinal detachments with breaks below 4 and 8 o'clock were more prone to SB surgery failure 10 .…”