Our Summary

This research paper reviews and compares two common surgical treatments for a type of retinal detachment known as rhegmatogenous retinal detachment. The two procedures are pars plana vitrectomy (PPV) and scleral buckling (SB). It evaluated how good these treatments were at improving vision, how often they successfully reattached the retina, the length of the operation, and any side effects.

After looking at 41 different studies (both randomized controlled trials and observational studies), they found that both procedures had similar success rates in reattaching the retina. However, SB had a slightly better result in improving vision, but this difference was so small that it probably wouldn’t be noticeable to the patient.

Additionally, patients who underwent SB were less likely to develop cataracts and have accidental tears or breaks (iatrogenic breaks) during the operation. However, they were more likely to have bleeding under or within the retina (choroidal/subretinal hemorrhage), detachment of the layer of blood vessels in the back of the eye (choroidal detachment), and leftover fluid under the retina (residual subretinal fluid).

So, while both procedures are effective, each comes with its own set of potential risks and benefits that need to be considered.

FAQs

  1. What is the success rate of pars plana vitrectomy (PPV) and scleral buckling (SB) in treating rhegmatogenous retinal detachment?
  2. What potential side effects can occur from undergoing a scleral buckling surgery?
  3. How does the efficacy in improving vision compare between the pars plana vitrectomy (PPV) and scleral buckling (SB) procedures?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about scleral buckle surgery is to follow post-operative instructions carefully to ensure proper healing and reduce the risk of complications. This may include avoiding strenuous activities, taking prescribed medications as directed, attending follow-up appointments, and reporting any unusual symptoms or changes in vision immediately. Proper care after surgery is essential for a successful outcome.

Suitable For

Patients who are typically recommended scleral buckle surgery are those with rhegmatogenous retinal detachment, which is a type of retinal detachment caused by a tear or hole in the retina. This type of retinal detachment is often treated with SB because it helps close the tear or hole and reattach the retina to the back of the eye. Patients who have a retinal detachment that is not too severe or complicated may be good candidates for SB. Additionally, patients who are at a higher risk for developing cataracts or accidental tears during surgery may also benefit from SB. Ultimately, the decision to undergo SB should be made in consultation with a retinal specialist who can assess the individual patient’s specific condition and recommend the most appropriate treatment option.

Timeline

Before scleral buckle surgery, a patient will typically undergo a comprehensive eye examination to diagnose the retinal detachment. This may involve imaging tests such as ultrasound or optical coherence tomography (OCT). The patient may also need to have blood tests and a general physical examination to ensure they are healthy enough for surgery.

During the surgery, the patient will be given anesthesia to numb the eye and surrounding area. The surgeon will make an incision in the eye and place a silicone band (scleral buckle) around the eye to support the detached retina. The surgeon may also drain any fluid that has accumulated under the retina.

After the surgery, the patient may experience discomfort, redness, and swelling in the eye. They may need to wear an eye patch for a few days to protect the eye as it heals. The patient will need to follow up with their surgeon for regular check-ups to monitor the healing process and ensure the retina is properly reattached.

Overall, the recovery process can take several weeks to months, and the patient may need to avoid strenuous activities and heavy lifting during this time. It is important for the patient to follow their surgeon’s instructions closely to ensure a successful outcome.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about scleral buckle surgery:

  1. What is the success rate of scleral buckle surgery in reattaching the retina?
  2. How long does the surgery typically take?
  3. What are the potential risks and complications associated with scleral buckle surgery?
  4. How will my vision be affected after the surgery?
  5. How long is the recovery period after scleral buckle surgery?
  6. Will I need to follow any specific post-operative care instructions?
  7. Are there any alternative treatments to scleral buckle surgery that I should consider?
  8. How experienced are you in performing scleral buckle surgery?
  9. What is the likelihood of needing additional surgeries or treatments after scleral buckle surgery?
  10. What can I expect in terms of long-term outcomes and potential complications?

Reference

Authors: Dhoot AS, Popovic MM, Nichani PAH, Eshtiaghi A, Mihalache A, Sayal AP, Yu H, Wykoff CC, Kertes PJ, Muni RH. Journal: Surv Ophthalmol. 2022 Jul-Aug;67(4):932-949. doi: 10.1016/j.survophthal.2021.12.005. Epub 2021 Dec 9. PMID: 34896191