Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy

ObjectiveTo report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD).Methods and analysisData from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research.ResultsPPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of the PPV, PPV/SB and SB groups.ConclusionsIn this large, single institution, retrospective case series, we report surgical outcomes for patients with primary non-complex RRD managed with PPV, SB or PPV/SB in the modern era of small-gauge vitrectomy. We demonstrate that primary PPV without adjunct SB provides excellent anatomic and visual outcomes irrespective of lens status, macular involvement or pathology location.

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Anatomic and Visual Outcomes of 23-G Vitrectomy without Scleral Buckling for Primary Rhegmatogenous Retinal Detachment

European Journal of Ophthalmology ◽

10.5301/ejo.5000234 ◽

2013 ◽

Vol 23 (3) ◽

pp. 417-422 ◽

Cited By ~ 8

Author(s):

Marta S. Figueroa ◽

Inés Contreras ◽

Susana Noval ◽

L. Wu ◽

J. F. Arevalo ◽

...

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Visual Outcomes

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Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment

European Journal of Ophthalmology ◽

10.1177/1120672120940209 ◽

2020 ◽

pp. 112067212094020

Author(s):

Paolo Radice ◽

Elisa Carini ◽

Patrizio Seidenari ◽

Andrea Govetto

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Vision Loss ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Full Thickness Macular Hole ◽

Air Tamponade ◽

Subretinal Fluid Drainage ◽

Anatomical Success

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

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Repair of Traumatic Rhegmatogenous Retinal Detachment Combined with Congenital Falciform Retinal Detachment

Case Reports in Ophthalmology ◽

10.1159/000485550 ◽

2018 ◽

Vol 9 (1) ◽

pp. 55-59

Author(s):

Fukutaro Mano ◽

Kuo-Chung Chang ◽

Tomiya Mano

Keyword(s):

Retinal Detachment ◽

Patient Outcomes ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Retrospective Case ◽

Hand Motion ◽

Corrected Visual Acuity ◽

Pars Plana Lensectomy ◽

Pars Plana

Purpose: To report a case of surgical repair of traumatic rhegmatogenous retinal detachment combined with congenital falciform retinal detachment (FRD). Methods: A retrospective case report. Results: A 36-year-old man with traumatic rhegmatogenous retinal detachment complicating a previously known FRD was successfully treated despite residual FRD following pars plana lensectomy, vitrectomy, and encircling scleral buckling. His best corrected visual acuity improved from hand motion at 50 cm to 20/1,000. Conclusion: We concluded that the root of the FRD is susceptible to trauma because of the contraction of fibrovascular tissue. The early intervention of modern vitrectomy to traumatic rhegmatogenous retinal detachment complicating a previously known FRD is an important consideration for enhanced quality of care and optimal patient outcomes.

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Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9434 ◽

2021 ◽

Author(s):

Matthew R. Starr ◽

Edwin H. Ryan ◽

Anthony Obeid ◽

Claire Ryan ◽

Xinxiao Gao ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Scleral Buckle ◽

Scleral Tunnel ◽

The Mean ◽

Anatomic Success

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.

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Anatomical and functional outcomes of surgery of rhegmatogenous retinal detachment

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v2i2.3720 ◽

1970 ◽

Vol 2 (2) ◽

pp. 132-137 ◽

Cited By ~ 1

Author(s):

H Sharma ◽

SN Joshi ◽

JK Shrestha

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Success Rate ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Scleral Buckling ◽

Pars Plana ◽

A Prospective Study ◽

Physiological Outcome

Introduction: Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition. Objective: To evaluate the anatomical and functional outcome of surgery of RRD. Materials and methods: A prospective study of interventional case series was designed including 50 consecutive patients with RRD in a tertiary level eye center in Kathmandu. The patients underwent scleral buckling (SB) or pars plana vitrectomy (PPV) according to the proliferative vitreo-retinopathy (PVR) changes. All the patients had at least 3 months of follow-up. The anatomical and physiological outcome measures were primary retinal reattachment and improvement in visual acuity respectively. The surgery was considered successful when there was attachment of retina after the first surgery. Results: The mean age of these patients at the time of presentation was 46.24 ± 19.82 years. Of 50, sixty-six percent of the patients underwent SB and 34 % underwent PPV. Primary surgical success rate was 88 %. While comparing the initial best corrected visual acuity (BCVA) with the final, 72% had an improvement, 12 % unchanged and 16 % had a deteriorated visual acuity. Conclusion: The visual acuity improves and the anatomical success rate is high in the majority of the patients after surgery for rhegmatogenous retinal detachment. Keywords: rhegmatogenous retinal detachment; scleral buckling; pars plana vitrectomy; anatomical outcome; physiological outcome DOI: 10.3126/nepjoph.v2i2.3720 Nep J Oph 2010;2(2) 132-137

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Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis

Journal of Ophthalmology ◽

10.1155/2016/4538193 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Yong-Kyu Kim ◽

Wontae Yoon ◽

Jae Kyoun Ahn ◽

Sung Pyo Park

Keyword(s):

Retinal Detachment ◽

High Myopia ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Surgical Approaches ◽

Success Rates ◽

Visual Outcomes ◽

Pars Planitis ◽

Preoperative Risk Factors ◽

Anatomical Success

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis.Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups.Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p<0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%,p=0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors.Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

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Scleral buckling versus vitrectomy for macula-off rhegmatogenous retinal detachment as accessed with spectral-domain optical coherence tomography: a retrospective observational case series

BMC Ophthalmology ◽

10.1186/1471-2415-13-12 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 8

Author(s):

Chunmei Huang ◽

Te Fu ◽

Tonghe Zhang ◽

Xinyi Wu ◽

Qiang Ji ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Scleral Buckling ◽

Spectral Domain ◽

Optical Coherence

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Montgomery and informed consent during Covid-19: Pneumatic retinopexy versus pars plana vitrectomy or scleral buckling for retinal detachment repair

Medico-Legal Journal ◽

10.1177/0025817220984009 ◽

2021 ◽

pp. 002581722098400

Author(s):

G Kiew ◽

AV Poulson ◽

DK Newman ◽

P Alexander ◽

MP Snead

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Scleral Buckling ◽

Success Rates ◽

Retrospective Case ◽

Pneumatic Retinopexy ◽

Co Morbidity ◽

Pars Plana ◽

The Uk

Recent reports suggest that the use of an outpatient-based procedure (pneumatic retinopexy, PR) for retinal detachment repair should be encouraged within the UK, especially in light of Covid-19 and possible restrictions/competing demands on access to operating theatres. It is therefore essential that patients receive comprehensive information about the risks and benefits of this approach compared with a formal surgical repair either by pars plana vitrectomy (PPV) and/or scleral buckling (SB). We report a retrospective case series of retinal detachments (RD) satisfying the strict selection criteria for PR but who were managed with formal surgery. Single-operation success rate for PPV/SB at six months follow-up was 93.8% in our study, higher than published primary success rates for PR (60–80%). When counselling patients for possible PR, the ease, speed and potentially reduced co-morbidity of an outpatient-based procedure needs to be balanced against its significantly higher failure rate in comparison with primary PPV/SB.

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Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311787 ◽

2018 ◽

Vol 103 (4) ◽

pp. 481-487 ◽

Cited By ~ 1

Author(s):

Viviana Cacioppo ◽

Andrea Govetto ◽

Paolo Radice ◽

Gianni Virgili ◽

Antonio Scialdone

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Key Factor ◽

Subretinal Fluid Drainage ◽

Functional Deterioration

PurposeTo investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.MethodsThis institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.ResultsNinety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).ConclusionThe incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.

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