Scleral buckling as a standalone surgery in the era of pars plana vitrectomy: a 10-year retrospective cohort study

TL;DR

This study shows that scleral buckling remains a safe and effective treatment for retinal detachment, especially in younger patients.

Contribution

The paper provides 10 years of real-world data on scleral buckling outcomes in a Canadian eye center.

Findings

90.4% of patients achieved anatomical success with a single surgery.

Visual acuity improved significantly by 12 months and at final follow-up.

Male sex and chronic retinal detachment were associated with worse outcomes.

Abstract

Scleral buckling (SB) is an established treatment for rhegmatogenous retinal detachment (RRD). Once the gold standard for RRD repair, SB became less performed with the rise of pars plana vitrectomy (PPV). This retrospective interventional cohort study aims to provide 10 years of real-world data on SB surgical outcomes in a Canadian tertiary eye center.

Patients undergoing primary SB surgery at the CHU de Québec between January 2014 and December 2023 for primary RRD with at least 3 months of postoperative follow-up were included. Multiple linear and logistic regression models were developed to identify variables associated with final BCVA and single surgery anatomical success (SSAS).

A total of 187 phakic patients undergoing primary SB surgery with a median [Q1, Q3] follow-up (FU) of 23.0 [11.0, 38.9] months were included. Females constituted 56.1% (n = 105) of the cohort with a median age at surgery of 36.9 [28.6, 47.0] years. Most patients did not have a preoperative posterior vitreous detachment (n = 161, 86.1%). Macula status was on for 109 (58.3%), off for 46 (24.6%), and split for 32 (17.1%) patients. Median RRD extent was of 4.0 [3.0, 5.0] clock hours, with the preoperative number of retinal breaks being of 2.0 [1.0, 3.0]. Inferior RRD associated with inferior breaks was present in 101 (54.0%) eyes. SSAS was achieved in 169 (90.4%) cases, with 184 (98.4%) patients achieving retinal reattachment at last follow-up. BCVA progressed from baseline median values of 0.14 [0.00, 0.40] logMAR, improving by 12 months (0.12 [0.02, 0.30], p = 0.004) and by final follow-up (0.10 [0.00, 0.28], p < 0.001). Male sex was a negative predictor of SSAS (p = 0.008), while SF6 gas tamponade was a positive predictor (p = 0.035). Chronicity of RRD (p = 0.012) and worse preoperative BCVA (p < 0.001) were associated with worse final BCVA.

The use of primary SB as a standalone surgery continues to be a safe and effective technique for RRD repair, specifically in young phakic patients with no PVD; or when PPV may not be the preferred option to preserve lens state and avoid iatrogenic retinal breaks, two well-documented complications of vitrectomy.

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