Primary vitrectomy versus scleral buckling for the treatment of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled clinical trials

Abstract

Purpose: To compare the efficacy of pars plana vitrectomy (PPV) with that of scleral buckling (SB) in the treatment of uncomplicated, primary rhegmatogenous retinal detachment (RRD).

Materials and methods: Meta-analysis of randomized controlled trials (RCTs) were performed. Phakic and pseudophakic/aphakic eyes were analyzed separately. Searches of PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted. Outcome measures included primary and final anatomic success, final visual success, and development of post-operative proliferative vitreoretinopathy (PVR) and/or post-operative cataract.

Results: Three RCTs of phakic eyes (n = 523) and four RCTs of pseudophakic/aphakic eyes (n = 690) were included in the meta-analysis. For the phakic group, searches of PPV and SB yielded similar results in terms of primary/final retinal re-attachment and post-operative PVR. In the SB arm, visual acuity (VA) was better (heterogeneity p = 0.14; OR = 0.50, 95%CI, 0.31-0.82; p = 0.005) and the rate of post-operative cataract lower (heterogeneity p = 0.42; OR = 4.18; 95%CI, 2.75-6.35, p < 0.00001) than in the PPV group. In the pseudophakic/aphakic group, re-attachment rates after a single operation did not differ between the two procedures (random effect model: OR = 1.77; 95% CI, 0.80-3.91; p = 0.16). Final anatomic success outcomes were in favor of PPV (OR = 1.97; 95% CI, 1.04-3.73; p = 0.04). Final visual success and post-operative PVR rates did not differ statistically between the two arms (OR = 1.49; 95%CI, 0.82-2.68; p = 0.19; and OR = 0.85; 95% CI, 0.58-1.26; p = 0.42, respectively).

Conclusions: SB is superior in terms of final VA and occurrence of post-operative cataract in uncomplicated phakic RRDs. PPV is more likely to achieve a favorable final re-attachment in pseudophakic/aphakic RRDs.