Primary Rhegmatogenous Retinal Detachment Repair by Pars Plana Vitrectomy with and without Scleral Buckling: A Propensity Score Analysis.

Abstract

Purpose: To evaluate the anatomical and visual outcomes of patients with rhegmatogenous retinal detachment (RRD) who received primary repair by combined pars plana vitrectomy with scleral buckling (PPV/SB) or pars plana vitrectomy (PPV) alone by using a propensity analysis.

Patients and methods: This study was a single center retrospective observational study. Medical records of patients who underwent surgical interventions between January 2013 and December 2019 were retrospectively reviewed. The single surgery anatomic success (SSAS) and final anatomic success were the primary outcomes, whereas the final visual acuity changes was the secondary outcome.

Results: This study included a total of 683 patients (683 eyes), with a median (interquartile range, IQR) follow-up duration of 13 (5.5 to 28.8) months. Of them, 211 patients (30.9%) underwent PPV/SB, while 472 patients (69.1%) underwent PPV as their primary procedure. The two treatment groups did not significantly differ in the risk of achieving SSAS (weighted risk difference: 0.012, 95% confidence interval (CI): -0.067 to 0.092, p value = 0.776) or achieving final retinal anatomic attachment (weighted risk difference: -0.038, 95% CI: -0.106 to 0.030, p value = 0.272). The occurrence of proliferative vitreoretinopathy was identical between the two treatment groups (56 patients (26.5%) for the PPV/SB group and 104 patients (22.0%) for the PPV group), p = 0.199. Nonetheless, the patients who received PPV alone showed a significantly greater mean improvement in VA (weighted mean difference; 0.295, 95% CI; 0.150, 0.440, p <0.001).

Conclusion: This work supports the findings that adding SB to PPV had little impact on anatomical results (either a single surgical success rate or the overall final success rate) for RRD repair. Although PPV alone is shown to improve vision, confirmation of these associations requires further prospective studies using standardized surgical techniques.