Pars plana vitrectomy versus scleral buckle: A comprehensive meta-analysis of 15,947 eyes

Dhoot, Arjan S.; Popović, Marko; Nichani, Prem; Eshtiaghi, Arshia; Mihalache, Andrew; Sayal, Aman P; Yu, Hannah J.; Wykoff, Charles C.; Kertes, Peter J.; Muni, Rajeev H.

doi:10.1016/j.survophthal.2021.12.005

Cited by 26 publications

(35 citation statements)

References 46 publications

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“…Two recent meta-analysiss recently concluded that there were no significant differences between the re-attachment rates of PPV vs SB. 99 , 100 A meta-analysis that included 15,661 eyes from 38 studies compared the outcomes of eyes treated with PPV and those treated with PPV plus SB. PPV plus SB had a higher single operation success rate, but the final reattachment rate was similar between the two groups.…”

Section: Outcomes Of Retinal Re-attachment Proceduresmentioning

confidence: 99%

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Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Pimentel¹,

Shih²,

Wu³

2022

OPTH

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Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.

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Section: Outcomes Of Retinal Re-attachment Proceduresmentioning

confidence: 99%

“…PPV was associated with a higher incidence of cataract, progression of cataract and iatrogenic retinal breaks, whereas SB was associated with hypotony, choroidal detachment, subretinal hemorrhage, residual subretinal fluid, strabismus and diplopia. 99 , 100 , 108 …”

Section: Outcomes Of Retinal Re-attachment Proceduresmentioning

confidence: 99%

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Pimentel¹,

Shih²,

Wu³

2022

OPTH

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“…4 For vitreoretinal surgeries, scleral buckles were more likely to be associated with choroidal detachments than small gauge pars plana vitrectomies (PPVs) in meta-analyses (4.1% to 8.8% vs. 0%, P<0.05). 5,6 Risk factors included older age, choroidal drainage (43.9% drainage vs. 5.9% without), more quadrants buckled (33% to 57.1% if more than 1 quadrant vs. 7.7% with 1 quadrant), and more posterior locations of the buckles (68% for those with the posterior extent 12 to 12.5 mm from the limbus vs. 11.1% if only 9.5 to 11.5 mm from the limbus). 7 Packer et al 7 theorized that a greater extent of buckling increased obstruction through the vortex veins.…”

Section: Serous Choroidal Detachmentsmentioning

confidence: 99%

Management of Serous and Hemorrhagic Choroidal Detachments and Complications

Williams

Scholle

Leung

2022

International Ophthalmology Clinics

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“…The result of this event is the separation of the neurosensory retina from the retinal pigment epithelium (RPE), requiring early surgical management [ 1 ]. Considering the morphology of the RRD, a high anatomical success rate of 82–95% has been detected following appropriate surgery [ 2 , 3 , 4 , 5 , 6 , 7 ]. However, the anatomical success is not always linked to functional visual recovery and involvement of the macula in the retinal detachment pathogenesis is one of the most important prognostic factors for visual prognosis [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Early Structural and Vascular Changes after Within-24 Hours Vitrectomy for Recent Onset Rhegmatogenous Retinal Detachment Treatment: A Pilot Study Comparing Bisected Macula and Not Bisected Macula

D’Aloisio

Gironi

Verdina

et al. 2022

JCM

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Background: In this study we aimed at investigating macular perfusion/anatomical changes in eyes with early onset rhegmatogenous retinal detachment (RRD) after prompt surgery within 24 hours, comparing a bisected macula and not bisected macula RRD. Methods: In this prospective observational study, 14 eyes of 14 patients who underwent within-24 hours vitreoretinal surgery for early onset RRD were enrolled. Patients were further divided into two subgroups: the not bisected macula group (NBM group) and the bisected macula group (BM group). At baseline and 3-month follow up, macular architecture and vessel analysis were assessed using optical coherence tomography angiography (OCTA) imaging. In detail, quantitative and qualitative analyses of the macular area were performed to quantify topographical retinal perfusion changes after surgery, calculating the foveal avascular zone (FAZ), vessel density (VD) and vessel length density (VLD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Most cases (43%) were superotemporal RRD. Primary retinal reattachment was obtained in all cases, without recurrences within 3-month follow up. After surgery, a significant FAZ enlargement was observed at both the SCP and DCP level (p < 0.001; p < 0.05), with a significant effect of time noted between the two time points in the NBM and BM subanalysis (F = 3.68; p < 0.017). An excellent functional outcome was maintained for the whole follow-up. On the other hand, after surgery, perfusion parameters did not change significantly apart from the vessel density of the inferior macular sector at the DCP level (p = 0.03). Conclusions: Our findings suggest that the macular perfusion of eyes with RRD is still preserved if the surgery is performed really promptly, thus highlighting the great importance of a correct timing for surgery. OCTA analysis allows for a better understanding of the pathophysiological mechanisms underneath early vascular microarchitecture modifications of the posterior pole in retinal detachment, differentiating the two types of RRD not completely involving the fovea (BM and NBM).

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Pars plana vitrectomy versus scleral buckle: A comprehensive meta-analysis of 15,947 eyes

Cited by 26 publications

References 46 publications

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Management of Serous and Hemorrhagic Choroidal Detachments and Complications

Early Structural and Vascular Changes after Within-24 Hours Vitrectomy for Recent Onset Rhegmatogenous Retinal Detachment Treatment: A Pilot Study Comparing Bisected Macula and Not Bisected Macula

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