Comparison of surgical interventions for retinal detachment

Citation: Znaor L, Medic A, Binder S, Vucinovic A, Marin Lovric J, Puljak L. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD009562. DOI: 10.1002/14651858.CD009562.pub2

What is the aim of this review?
The aim of this Cochrane Review was to find out how pars plana vitrectomy (PPV) compares to scleral bucklingĀ in the treatment of retinal detachment. The Cochrane Review authors searched for relevant studies to answer this question and found 10 studies.

Key messages
There may be little or no difference between PPV and scleral bucklingĀ in terms of success of the operation and vision achieved. PPV may be associated with less recurrence of the detachment. Some adverse events, such as cataract progression and new iatrogenic breaks, appeared to be more common in the PPV group whereas choroidal detachment was more common in the scleral buckling group.

What was studied in the review?
Rhegmatogenous retinal detachment (RRD) is the most common type of retinal detachment. It is the separation of the retina (the light-sensitive tissue at the back of the eye) from its underlying layer in the eye. This occurs because of retinal breaks or tears, which lead to the vitreous gel (the clear substance that fills the centre of the eye) leaking under the retina.

PPV is a surgical procedure which involves removing the vitreous from the eye through the pars plana (part of the middle layer of the eye).

Scleral buckling surgery requires applying local pressure on to the retina by suturing (stitching) material (silicone) onto the outer part of the eye (sclera), to push it inwards. PPV involves removal of the vitreous, using a laser to seal the break, and injecting silicone oil into the vitreous cavity to apply pressure to the retina. PPV may be combined with scleral buckling surgery if needed.

What are the main results of the review?
The Cochrane Review authors found 10 relevant studies with 1307 participants from Europe, India, Iran, Japan and Mexico. All studies compared scleral buckling with PPV alone or combined with scleral buckling for treating RRD. All studies had at least three months of follow-up. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.

The results of the review show that for people with RRD, there is little or no difference between PPV and scleral buckling in terms of primary success rate, visual acuity and final anatomical success (low-certainty evidence); PPV is associated with lower rates of retinal redetachment compared to scleral buckling (low-certainty evidence); there was only very low-certainty evidence on number of operations required and quality of life.

All the studies reported adverse effects (side effects). Cataract development or progression was more common in the PPV group, choroidal detachment was more common in the scleral buckling group and new/iatrogenic breaks were observed only in the PPV group.

How up-to-date is this review?
The Cochrane Review authors searched for studies that had been published up to 5 December 2018.