Scleral buckling versus primary vitrectomy in patients with rhegmatogenous retinal detachment at high risk for failure to reattach

Background: Rhegmatogenous retinal detachment (RRD) is caused by separation of the neurosensory retina from the underlying retinal pigment epithelium and is a potentially blinding condition. RRD can be surgically treated with scleral buckling (SB) or pars plana vitrectomy (PPV). In recent years, a number of studies have evaluated SB with or without PPV versus PPV alone for patients with RRD. However, all major randomized controlled trials and the majority of reviews have excluded patients at high risk for failure to reattach.

Methods: In a retrospective, nonrandomized study, 678 patients were identified from billing data as having RRD between April 1, 2010 and August 1, 2012 at one large retina practice. Patients were considered at high risk for failure to reattach if they presented with RRD in 2+ quadrants, retinal tears larger than 1 clock hour, preoperative proliferative vitreoretinopathy (PVR), or vitreous hemorrhage.

Results: 75 patients were identified as being at high risk for failure to reattach and were followed for a mean of 5.3 months. Patients treated with SB (n=44) were significantly more likely to have anatomic success after a single surgery compared to those treated with PPV alone (n=31) (75.0% for SB vs. 51.6% for PPV alone; p=0.049). Development of PVR and best-corrected visual acuity at 3 months post-procedure and final follow-up were not significantly different between the two treatment groups.

Conclusion: For patients with RRD at high risk for failure to reattach, SB was associated with significantly higher anatomical success rates compared to PPV alone.