Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole

Abstract

Aim-To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. Methods-All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and 2 tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. Results-Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) Conclusions-A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial eVect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis (Br J Ophthalmol 1999;83:944-948) Macular hole is an idiopathic condition that typically aVects individuals in their sixth to seventh decade of life.1 In 1988, Gass postulated the role of tangential vitreous traction in the development of idiopathic macular hole. 3 4 Currently, the success rate for patients undergoing vitrectomy for macular hole ranges from 70% to 90%.5 With these results, surgical intervention has become the standard of care for patients with this condition.In two of the earlier series, the complication rates following macular hole surgery were reported to be quite low. Wendel et al reported a 1% detachment rate in a retrospective review of 170 eyes undergoing macular hole surgery. 6Smiddy and co-workers reported a 2% detachment rate in 90 eyes undergoing macular hole surgery with transforming growth factor (TGF-) adjuvant therapy.7 These statistics are in keeping with the suggested retinal detachment rates following vitrectomy surgery for epiretinal membranes.8 In a more recent study Park et al reported a much higher complication rate. In that article the authors noted a 14% rate of retinal detachment. 9 This detachment rate was corroborated by the results from a prospective multicentred trial, which reported an 11% incidence of retinal detachment.

Entry‐site‐related retinal detachment after pars plana vitrectomy

“…Comparing the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone, Chang et al. (1999) reported a detachment rate of 5.9% in the first group compared to 13.2% in the second group.…”

Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study

“…Several large scale studies have demonstrated that postoperative retinal detach-ment occurred in 11% to 14% of cases. [27][28][29] In view of this potential complication, additional prophylactic scleral buckle or indirect ophthalmoscopic laser cerclage from the ora serrata to the equator on top of standard vitrectomy have been used to prevent retinal detachment after macular hole surgery. 28 30 Potential retinal and RPE damages related to the use of ICG for ILM peeling have been reported previously in some studies.…”

Enhanced internal search for iatrogenic retinal breaks in 20-gauge macular surgery

“…Scleral buckling,8 360° laser9 or circular cryoretinopexy10 were deemed appropriate prophylactic measures but these are in fact quite invasive and impose risks of their own. Therefore, specifically targeting retinal breaks seems a more efficient strategy to minimise the occurrence of RRD.…”