Surgical complications of primary rhegmatogenous retinal detachment: a meta-analysis

Abstract

Background: To investigate the surgical complications of scleral buckling (SB) and pars plana vitrectomy (PPV) performed on primary rhegmatogenous retinal detachment (RRD) and to discover which surgical procedures bring fewer complications.

Methods: An electronic literature search using the PubMed database, ISI Web of Knowledge and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and observational studies comparing SB with PPV on primary RRD. Outcome measures included intra-operative complications and early and late post-operative complications.

Results: During the operation, significantly less subretinal hemorrhage occurred in the PPV group than in the SB group (OR = 4.71; 95%CI, 1.33-16.64; p = 0.02) and the hypotony incidence was significantly higher in the SB group (OR = 18.24; 95%CI, 2.37-140.44; p = 0.005); however, the occurrence of iatrogenic breaks was significantly lower in the SB group (OR = 0.05; 95%CI, 0.01-0.21; p<0.0001). In the early stage of post-operation, significantly higher incidence of choroidal detachment was identified in the SB group than in the PPV group (OR = 10.19; 95%CI, 2.36-44.09; p = 0.002); patients undergoing SB had significantly higher odds of residual subretinal fluid (OR = 14.71; 95%CI, 1.84-117.32; p = 0.01); the occurrence of high intraocular pressure was significantly lower in the SB group (OR = 0.46; 95%CI, 0.23-0.89; p = 0.02); and no significant difference was shown in the incidence of epithelia defect (p = 0.37) between the two groups. In the late stage of post-operation, the incidence of diplopia/extraocular muscle dysfunction was significantly higher in the SB group (OR = 4.04; 95%CI, 1.30-12.52; p = 0.02); and significantly less cataract was observed in the SB group (OR = 0.20; 95%CI, 0.14-0.30; p<0.00001); no significant difference was found in the incidences of cystoid macular edema (p = 0.65), macular pucker (p = 0.52), post-operative proliferative vitreoretinopathy (p = 0.73) and epiretinal membrane (p = 0.47) in other late post-operative complications.

Conclusions: This meta-analysis suggests that PPV could be considered as potential surgical management on primary RRD.

Fig 1. Flow chart of the articles selection process.

Fig 2. Summary results of intra-operative complications.

The forest plot showed the subretinal hemorrhage (A), hypotony (B), iatrogenic breaks (C) along with their associated 95%CIs, comparing SB-treated eyes with PPV-treated eyes.

Fig 3. Summary results of early post-operative complications.

The forest plot showed the choroidal detachment (A), SRF (B), elevated IOP (C), epithelia defect (D) along with their associated 95%CIs, comparing SB-treated eyes with PPV-treated eyes.

Fig 4. Summary results of late post-operative complications.

The forest plot showed the diplopia/EOM dysfunction (A), cataract (B), CME (C), macular pucker (D),post-operative PVR (E), epiretinal membrane (F) along with their associated 95%CIs, comparing SB-treated eyes with PPV-treated eyes.