Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives

Abstract

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

<p>Wide-angled endoillumination vs traditional scleral buckling surgery for retinal detachment &ndash; a comparative study</p>

“…Scleral buckle technique possesses some clear advantage over vitrectomy by being an extraocular surgery and a preferred technique for young phakic patients 5. A comparison of the SB vs primary vitrectomy in RRD study (SPR) showed in the subgroup analysis that phakic patients had better visual outcomes, less cataract progression, and needed fewer retina-affecting procedures in the SB group compared with the vitrectomy group 6.…”

<p>Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment</p>

“…Since first introduced by Machemer in 1971, pars plana vitrectomy (PPV) has been shown to be an effective management option for rhegmatogenous retinal detachment (RRD) 1–3. Although scleral buckling is preferred in some specific situations,4,5 PPV is now generally accepted as the primary procedure for management of RRD. The most commonly used techniques consist of PPV, barrier laser photocoagulation, and the use of vitreous tamponade.…”

A Pilot Clinical Study of Treating Rhegmatogenous Retinal Detachment by Silicone Rubber Balloon Scleral Buckling

“…Scleral buckling, which requires the surgeon to sew a silicone strip or sponge to the outside of the eye, was first introduced in the 1950s and had been the standard method used for treating RRD for several decades. 8 , 9 Although the application of PPV has significantly increased and become the most commonly used procedure, even with the evolution of vitrectomy machines and related instruments, 9 – 16 pars plana vitrectomy surgery still has disadvantages, such as the acceleration of cataracts in phakic eyes, a lower initial rate of anatomical success, increased risk of proliferative vitreoretinopathy and an epiretinal membrane, and a higher cost. 8 , 17 – 21 However, scleral buckling is an extraocular procedure, does not require that a posterior vitreous detachment be present, and does not promote cataract formation; so, it still has some merits and continues to play an important role in retinal reattachment surgery.…”

“… 8 , 9 Although the application of PPV has significantly increased and become the most commonly used procedure, even with the evolution of vitrectomy machines and related instruments, 9 – 16 pars plana vitrectomy surgery still has disadvantages, such as the acceleration of cataracts in phakic eyes, a lower initial rate of anatomical success, increased risk of proliferative vitreoretinopathy and an epiretinal membrane, and a higher cost. 8 , 17 – 21 However, scleral buckling is an extraocular procedure, does not require that a posterior vitreous detachment be present, and does not promote cataract formation; so, it still has some merits and continues to play an important role in retinal reattachment surgery. 22 – 30 Indeed, PPV surgery will remain an ideal treatment option in selected cases, especially in patients who are younger, in phakic eyes, and in limited retinal detachment, particularly with a hole in the lattice or an inferior location, even in subjects with high myopia.…”

“… 31 – 33 However, we cannot ignore the fact that some of the shortcomings of scleral buckling—such as it requiring more anesthesia and higher surgical skills, hence meaning it is difficult to teach—may still induce change of refractive errors or diplopia postoperatively. 8 For these reasons, PPV surgery is still undergoing modifications and has evolved along with advances in the materials, instrumentation, and surgical techniques.…”