Surgical Approaches in Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis Comparing Vitrectomy vs. Vitrectomy Combined with Scleral Buckling, Lens-Sparing vs. Phako Procedures
Aim: This study aimed to assess and compare the functional and anatomical
results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral
buckling (SB), and lens-sparing versus phaco-procedures for treating
rhegmatogenous retinal detachment. Methods: A comprehensive literature
search was performed using the Web of Science, MEDLINE, EMBASE, and Cochrane
Library databases to retrieve comparative studies. The main objective was to
assess the BCVA, while reattachment rates and ocular adverse events were considered secondary measures. Rev Manager
software was used for statistical analysis. Results: The literature
search identified 10 articles comprising 1518 eyes, with 682 eyes in the PPV
group, 193 eyes in the lens-sparing versus phaco-procedure group, and
643 eyes in the combined PPV and SB surgery group. Quality assessment revealed
a low risk of bias in most domains. The meta-analysis results revealed a
significant difference in postoperative BCVA between the PPV and PPV combined
with SB groups (WMD = −0.17,
95% CI [0.27,0.07], p = 0.001). The primary reattachment rates were 82.80% for PPV
alone and 87.52% for PPV combined with SB (p = 0.34). The final reattachment
rates did not differ significantly between PPV and PPV combined with SB (99%
vs. 99.8%; RR=1.00, 95% CI [1.01, 0.99], p = 0.96). PPV alone demonstrated a
significantly reduced risk of macular edema compared to PPV combined with
scleral buckling (9.9% vs. 23%; p = 0.006). The incidences of
macular hole development (p = 0.46), recurrent retinal detachment (p = 0.27),
proliferative vitreoretinopathy development (p = 0.48), epiretinal membrane
proliferation (p = 0.77), and limited choroidal hemorrhage (p = 0.69) were not
significantly different between the
References
[1]
Prasad, M., Xu, J., Agranat, J.S., Xia, W., Daley, S., Ness, S., Chen, X., Siegel, N.H., Stein, T.D. and Chung, J. (2023) Upregulation of Neuroinflammatory Protein Biomarkers in Acute Rhegmatogenous Retinal Detachments. Life, 13, Article 118. https://doi.org/10.3390/life13010118
[2]
Al-Hinai, A.S. and Al-Abri, M.S. (2013) Outcome of Rhegmatogenous Retinal Detachment Repair: Experience of a Tertiary Center in Oman. Oman Journal of Ophthalmology, 6, 179-182. https://doi.org/10.4103/0974-620X.122274
[3]
Chou, S.C., Yang, C.H., Lee, C.H., Yang, C.M., Ho, T.C., Huang, J.S., Lin, C.P., Chen, M.S. and Shih, Y.F. (2007) Characteristics of Primary Rhegmatogenous Retinal Detachment in Taiwan. Eye, 21, 1056-1061. https://doi.org/10.1038/sj.eye.6702397
[4]
Wood, M.L. and Gilbert, C. (2002) Retinal Detachment in East Africa. Ophthalmology, 109, 2279-2283. https://doi.org/10.1016/S0161-6420(02)01284-8
[5]
Malbran, E., Dodds, R.A., Hulsbus, R., Charles, D.E., Buonsanti, J.L. and Adrogue, E. (1990) Retinal Break Type and Proliferative Vitreoretinopathy in Nontraumatic Retinal Detachment. Graefe’s Archive for Clinical and Experimental Ophthalmology, 228, 423-425. https://doi.org/10.1007/BF00927254
[6]
Freeman, H.M. (1978) Fellow Eyes of Giant Retinal Breaks. Transactions of the American Ophthalmological Society, 76, 343-382.
[7]
Shunmugam, M., Ang, G.S. and Lois, N. (2014) Giant Retinal Tears. Survey of Ophthalmology, 59, 192-216. https://doi.org/10.1016/j.survophthal.2013.03.006
[8]
Le, N.T., Marshall, B., Houser, K.H. and Khandelwal, S.S. (2022) Combined Pars Plana Vitrectomy, Phacoemulsification and Intraocular Lens Implantation: A Review on the Advantages and Limitations of Phacovitrectomy. Touch Reviews in Ophthalmology, 16, 8-12. https://doi.org/10.17925/USOR.2022.16.1.8
[9]
Mora, P., Favilla, S., Calzetti, G., Berselli, G., Benatti, L., Carta, A., Gandolfi, S. and Tedesco, S.A. (2021) Parsplana Vitrectomy Alone versus Parsplana Vitrectomy Combined with Phacoemulsification for the Treatment of Rhegmatogenous Retinal Detachment: A Randomized Study. BMC Ophthalmology, 21, Article No. 196. https://doi.org/10.1186/s12886-021-01954-y
[10]
Kessner, R. and Barak, A. (2016) Pseudophakic Rhegmatogenous Retinal Detachment: Combined Pars Plana Vitrectomy and Scleral Buckle versus Pars Plana Vitrectomy Alone. Graefe’s Archive for Clinical and Experimental Ophthalmology, 254, 2183-2189. https://doi.org/10.1007/s00417-016-3381-3
[11]
Adelman, R.A., Parnes, A.J., Ducournau, D. and European Vitreo-Retinal Society Retinal Detachment Study Group (2013) Strategy for the Management of Uncomplicated Retinal Detachments: The European Vitreo-Retinal Society Retinal Detachment Study Report 1. Ophthalmology, 120, 1804-1808. https://doi.org/10.1016/j.ophtha.2013.01.070
[12]
Heimann, H., Bartz-Schmidt, K.U., Bornfeld, N., Weiss, C., Hilgers, R.D., Foerster, M.H. and Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group (2007) Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment: A Prospective Randomized Multicenter Clinical Study. Ophthalmology, 114, 2142-2154.E4. https://doi.org/10.1016/j.ophtha.2007.09.013
[13]
Hillier, R.J., Felfeli, T., Berger, A.R., Wong, D.T., Altomare, F., Dai, D., Giavedoni, L.R., Kertes, P.J., Kohly, R.P. and Muni, R.H. (2019) The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT). Ophthalmology, 126, 531-539. https://doi.org/10.1016/j.ophtha.2018.11.014
[14]
Tornambe, P.E., Hilton, G.F. and The Retinal Detachment Study Group (1989) Pneumatic Retinopexy. A Multicenter Randomized Controlled Clinical Trial Comparing Pneumatic Retinopexy with Scleral Buckling. Ophthalmology, 96, 772-784. https://doi.org/10.1016/S0161-6420(89)32820-X
[15]
Lee, S.Y., Ong, S.G., Wong, D.W. and Ang, C.L. (2009) Giant Retinal Tear Management: An Asian Experience. Eye, 23, 601-605. https://doi.org/10.1038/eye.2008.48
[16]
Goezinne, F., La Heij, E.C., Berendschot, T.T., Kessels, A.G., Liem, A.T., Diederen, R.M. and Hendrikse, F. (2010) Incidence of Redetachment 6 Months after Scleral Buckling Surgery. Acta Ophthalmologica, 88, 199-206. https://doi.org/10.1111/j.1755-3768.2008.01425.x
[17]
Neelakshi Bhagat, M. (2007) Retinal Detachments in the Pediatric Population: Part I. Journal of Pediatric Ophthalmology and Strabismus, 44, 13-23. https://doi.org/10.3928/01913913-20070101-01
[18]
Sultan, Z.N., Agorogiannis, E.I., Iannetta, D., Steel, D. and Sandinha, T. (2020) Rhegmatogenous Retinal Detachment: A Review of Current Practice in Diagnosis and Management. BMJ Open Ophthalmology, 5, e000474. https://doi.org/10.1136/bmjophth-2020-000474
[19]
Ferreira, N.P. and Neves, C.M. (2017) Rhegmatogenous Retinal Detachment Surgery—A Review. Revista Sociedade Portuguesa de Oftalmologia, 41, 1.
[20]
Escoffery, R.F., Olk, R.J., Grand, M.G. and Boniuk, I. (1985) Vitrectomy without Scleral Buckling for Primary Rhegmatogenous Retinal Detachment. American Journal of Ophthalmology, 99, 275-281. https://doi.org/10.1016/0002-9394(85)90356-3
[21]
Warren, A., Wang, D.W. and Lim, J.I. (2023) Rhegmatogenous Retinal Detachment Surgery: A Review. Clinical & Experimental Ophthalmology, 51, 271-279. https://doi.org/10.1111/ceo.14205
[22]
Brazitikos, P.D., Androudi, S., Christen, W.G. and Stangos, N.T. (2005) Primary Pars Plana Vitrectomy versus Scleral Buckle Surgery for the Treatment of Pseudophakic Retinal Detachment: A Randomized Clinical Trial. Retina, 25, 957-964. https://doi.org/10.1097/00006982-200512000-00001
[23]
Miki, D., Hida, T., Hotta, K., Shinoda, K. and Hirakata, A. (2001) Comparison of Scleral Buckling and Vitrectomy for Retinal Detachment Resulting from Flap Tears in Superior Quadrants. Japanese Journal of Ophthalmology, 45, 187-191. https://doi.org/10.1016/S0021-5155(00)00377-4
[24]
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. and PRISMA Group (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Annals of Internal Medicine, 151, 264-269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
[25]
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A. and Brennan, S.E. (2021) The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. International Journal of Surgery, 88, Article ID: 105906. https://doi.org/10.1016/j.ijsu.2021.105906
[26]
Sterne, J.A., Hernan, M.A., Reeves, B.C., Savovic, J., Berkman, N.D., Viswanathan, M., Henry, D., Altman, D.G., Ansari, M.T., Boutron, I., Carpenter, J.R., Chan, A.W., Churchill, R., Deeks, J.J., Hrobjartsson, A., Kirkham, J., Juni, P., Loke, Y.K., Pigott, T.D., Ramsay, C.R., Regidor, D., Rothstein, H.R., Sandhu, L., Santaguida, P.L., Schunemann, H.J., Shea, B., Shrier, I., Tugwell, P., Turner, L., Valentine, J.C., Waddington, H., Waters, E., Wells, G.A., Whiting, P.F. and Higgins, J.P. (2016) ROBINS-I: A Tool for Assessing Risk of Bias in Nonrandomized Studies of Interventions. The BMJ, 355, i4919. https://doi.org/10.1136/bmj.i4919
[27]
Guyatt, G., Oxman, A.D., Akl, E.A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., DeBeer, H., Jaeschke, R., Rind, D., Meerpohl, J., Dahm, P. and Schunemann, H.J. (2011) Grade Guidelines: 1. Introduction—GRADE Evidence Profiles and Summary of Findings Tables. Journal of Clinical Epidemiology, 64, 383-394. https://doi.org/10.1016/j.jclinepi.2010.04.026
[28]
Kim, M.S., Woo, S.J. and Park, K.H. (2021) Phacovitrectomy versus Lens-Sparing Vitrectomy for Rhegmatogenous Retinal Detachment Repair according to the Surgical Experience. Retina, 41, 1597-1604. https://doi.org/10.1097/IAE.0000000000003090
[29]
Al Taisan, A.A., Alshamrani, A.A., AlZahrani, A.T. and Al-Abdullah, A.A. (2021) Pars Plana Vitrectomy vs Combined Pars Plana Vitrectomy-Scleral Buckle for Primary Repair of Pediatrics Retinal Detachment. Clinical Ophthalmology, 15, 1949-1955. https://doi.org/10.2147/OPTH.S305910
[30]
Mehboob, M., Ghani, M.U., Khan, A. and Imran, M. (2018) Scleral Buckling and Pars Plana Vitrectomy versus Vitrectomy Alone for Primary Repair of Rhegmatogenous Retinal Detachment. Pakistan Journal of Medical & Health Sciences, 12, 716-720.
[31]
Mehta, S., Blinder, K.J., Shah, G.K. and Grand, M.G. (2011) Pars Plana Vitrectomy versus Combined Pars Plana Vitrectomy and Scleral Buckle for Primary Repair of Rhegmatogenous Retinal Detachment. Canadian Journal of Ophthalmology, 46, 237-241. https://doi.org/10.1016/j.jcjo.2011.05.003
[32]
Ong, S.S., Ahmed, I., Gonzales, A., Al-Fakhri, A.S., Al-Subaie, H.F., Al-Qhatani, F.S., Alsulaiman, S.M., Mura, M., Maia, M., Kondo Kuroiwa, D.A., Maia, N.T., Berrocal, M.H., Wu, L., Zas, M., Francos, J.P., Cubero-Parra, J.M., Arsiwala, L.T., Handa, J.T. and Arevalo, J.F. (2022) Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments: An International Multicenter Study. Ophthalmology Retina, 6, 595-606. https://doi.org/10.1016/j.oret.2022.03.004
[33]
Orlin, A., Hewing, N.J., Nissen, M., Lee, S., Kiss, S., D’Amico, D.J. and Chan, R.V. (2014) Pars Plana Vitrectomy Compared with Pars Plana Vitrectomy Combined with Scleral Buckle in the Primary Management of Noncomplex Rhegmatogenous Retinal Detachment. Retina, 34, 1069-1075. https://doi.org/10.1097/IAE.0000000000000050
[34]
Stangos, A.N., Petropoulos, I.K., Brozou, C.G., Kapetanios, A.D., Whatham, A. and Pournaras, C.J. (2004) Pars-Plana Vitrectomy Alone vs Vitrectomy with Scleral Buckling for Primary Rhegmatogenous Pseudophakic Retinal Detachment. American Journal of Ophthalmology, 138, 952-958. https://doi.org/10.1016/j.ajo.2004.06.086
[35]
Vangipuram, G., Zhu, A., Dang, S., Blinder, K.J. and Shah, G.K. (2022) Vitrectomy versus Combined Vitrectomy and Scleral Buckle for Repair of Primary Rhegmatogenous Retinal Detachment with Vitreous Hemorrhage. Ophthalmology Retina, 6, 228-233. https://doi.org/10.1016/j.oret.2021.10.001
[36]
Weichel, E.D., Martidis, A., Fineman, M.S., McNamara, J.A., Park, C.H., Vander, J.F., Ho, A.C. and Brown, G.C. (2006) Pars Plana Vitrectomy versus Combined Pars Plana Vitrectomy-Scleral Buckle for Primary Repair of Pseudophakic Retinal Detachment. Ophthalmology, 113, 2033-2040. https://doi.org/10.1016/j.ophtha.2006.05.038
[37]
Williams, P.D. and Hariprasad, S.M. (2014) Evolving Trends in Primary Retinal Detachment Repair: Microincisional Vitrectomy and the Role of OCT. Ophthalmic Surgery, Lasers and Imaging Retina, 45, 268-272. https://doi.org/10.3928/23258160-20140709-01
[38]
Chong, D.Y. and Fuller, D.G. (2010) The Declining Use of Scleral Buckling with Vitrectomy for Primary Retinal Detachments. Archives of Ophthalmology, 128, 1206-1207. https://doi.org/10.1001/archophthalmol.2010.190
[39]
Scott, I.U., VanVeldhuisen, P.C., Ip, M.S., Blodi, B.A., Oden, N.L., Altaweel, M., Berinstein, D.M. and Score Investigator Group (2018) Comparison of Monthly vs Treat-and-Extend Regimens for Individuals with Macular Edema Who Respond Well to Anti-Vascular Endothelial Growth Factor Medications: Secondary Outcomes from the SCORE2 Randomized Clinical Trial. JAMA Ophthalmology, 136, 337-345. https://doi.org/10.1001/jamaophthalmol.2017.6843
[40]
Nichani, P.A., Dhoot, A.S., Popovic, M.M., Eshtiaghi, A., Mihalache, A., Sayal, A.P., Yu, H.J., Wykoff, C.C., Kertes, P.J. and Muni, R.H. (2022) Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes. Ophthalmologica, 245, 296-314. https://doi.org/10.1159/000524888
[41]
Tan, A., Bertrand-Boiche, M., Angioi-Duprez, K., Berrod, J.P. and Conart, J.B. (2021) Outcomes of Combined Phacoemulsification and Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Comparative Study. Retina, 41, 68-74. https://doi.org/10.1097/IAE.0000000000002803
[42]
Demetriades, A.M., Gottsch, J.D., Thomsen, R., Azab, A., Stark, W.J., Campochiaro, P.A., de Juan Jr., E. and Haller, J.A. (2003) Combined Phacoemulsification, Intraocular Lens Implantation, and Vitrectomy for Eyes with Coexisting Cataract and Vitreoretinal Pathology. American Journal of Ophthalmology, 135, 291-296. https://doi.org/10.1016/S0002-9394(02)01972-4
[43]
Akiyama, A., Yokota, H., Aso, H., Hanazaki, H., Iwasaki, M., Yamagami, S. and Nagaoka, T. (2022) Comparison of Postoperative Stability of Intraocular Lenses after Phacovitrectomy for Rhegmatogenous Retinal Detachment. Journal of Clinical Medicine, 11, Article 3438. https://doi.org/10.3390/jcm11123438
[44]
Bellucci, C., Benatti, L., Rossi, M., Tedesco, S.A., Carta, A., Calzetti, G., Gandolfi, S. and Mora, P. (2022) Cataract Progression following Lens-Sparing Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment. Scientific Reports, 12, Article No. 22064. https://doi.org/10.1038/s41598-022-26415-4
[45]
Colyer, M.H., Barazi, M.K. and von Fricken, M.A. (2010) Retrospective Comparison of 25-Gauge Transconjunctival Sutureless Vitrectomy to 20-Gauge Vitrectomy for the Repair of Pseudophakic Primary Inferior Rhegmatogenous Retinal Detachment. Retina, 30, 1678-1684. https://doi.org/10.1097/IAE.0b013e3181dd6da1
[46]
Lindsell, L.B., Sisk, R.A., Miller, D.M., Foster, R.E., Petersen, M.R., Riemann, C.D. and Hutchins, R.K. (2017) Comparison of Outcomes: Scleral Buckling and Pars Plana Vitrectomy versus Vitrectomy Alone for Primary Repair of Rhegmatogenous Retinal Detachment. Clinical Ophthalmology, 11, 47-54. https://doi.org/10.2147/OPTH.S112190
[47]
Park, S.W., Lee, J.J. and Lee, J.E. (2018) Scleral Buckling in the Management of Rhegmatogenous Retinal Detachment: Patient Selection and Perspectives. Clinical Ophthalmology, 12, 1605-1615. https://doi.org/10.2147/OPTH.S153717
[48]
Mansukhani, S.A., Barkmeier, A.J., Bakri, S.J., Iezzi, R., Pulido, J.S., Khanna, C.L., Bennett, J.R., Hodge, D.O. and Sit, A.J. (2018) The Risk of Primary Open-Angle Glaucoma following Vitreoretinal Surgery—A Population-Based Study. American Journal of Ophthalmology, 193, 143-155. https://doi.org/10.1016/j.ajo.2018.06.010
[49]
Han, D.P., Lewis, H., Lambrou Jr., F.H., Mieler, W.F. and Hartz, A. (1989) Mechanisms of Intraocuular Pressure Elevation after Pars Plana Vitrectomy. Ophthalmology, 96, 1357-1362. https://doi.org/10.1016/S0161-6420(89)32715-1
[50]
Pole, C., Chehaibou, I., Govetto, A., Garrity, S., Schwartz, S.D. and Hubschman, J.P. (2021) Macular Edema after Rhegmatogenous Retinal Detachment Repair: Risk Factors, OCT Analysis, and Treatment Responses. International Journal of Retina and Vitreous, 7, Article No. 9. https://doi.org/10.1186/s40942-020-00254-9
[51]
Chatziralli, I., Theodossiadis, G., Dimitriou, E., Kazantzis, D. and Theodossiadis, P. (2021) Macular Edema after Successful Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Factors Affecting Edema Development and Considerations for Treatment. Ocular Immunology and Inflammation, 29, 187-192. https://doi.org/10.1080/09273948.2019.1652330
[52]
Schocket, L.S., Witkin, A.J., Fujimoto, J.G., Ko, T.H., Schuman, J.S., Rogers, A.H., Baumal, C., Reichel, E. and Duker, J.S. (2006) Ultrahigh-Resolution Optical Coherence Tomography in Patients with Decreased Visual Acuity After Retinal Detachment Repair. Ophthalmology, 113, 666-672. https://doi.org/10.1016/j.ophtha.2006.01.003
[53]
Odrobina, D.C., Michalewska, Z., Michalewski, J. and Nawrocki, J. (2010) High-Speed, High-Resolution Spectral Optical Coherence Tomography in Patients after Vitrectomy with Internal Limiting Membrane Peeling for Proliferative Vitreoretinopathy Retinal Detachment. Retina, 30, 881-886. https://doi.org/10.1097/IAE.0b013e3181c96952
