Effect of adjunctive scleral buckling on the outcomes of pars plana vitrectomy in retinal detachment repair
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 2 (2025),
31 July 2025
,
Page 57-64
https://doi.org/10.51329/mehdioptometry223
Abstract
Background: Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition requiring prompt surgical repair. Pars plana vitrectomy (PPV) and scleral buckling (SB) are standard surgical interventions for RRD, but the added value of combining these treatments is debated. While PPV offers enhanced visualization and safety in complex RRD cases, SB may provide additional support in selected scenarios. However, the impact on functional outcomes, particularly contrast sensitivity (CS), remains unclear. In this study, we compared the anatomical success and visual function, including best-corrected distance visual acuity (BCDVA) and CS, between patients with primary RRD who were treated with PPV alone and those who were treated with combined PPV+SB.Methods: This comparative cross-sectional study included consecutive patients with primary RRD who were treated at Madinah Teaching Hospital, Faisalabad, Pakistan, from October 2020 to July 2021. Participants underwent either 25-gauge PPV or 25-gauge PPV combined with SB, based on their clinical indications. BCDVA and CS were measured monocularly under standardized photopic conditions using the logarithm of the minimum angle of resolution (logMAR) visual acuity chart and the Pelli–Robson chart, respectively. Anatomical reattachment status was assessed by dilated fundus examination. Postoperative evaluations of BCDVA, CS, and anatomical reattachment rate were conducted at 1 day, 1 month, and 3 months after treatment.
Results: Ninety eyes of 90 patients with primary RRD were included (PPV: n = 45 eyes; PPV+SB: n = 45 eyes). The PPV group was approximately a decade younger (45.2 vs. 55.4 years, P < 0.05), while sex distribution was similar in both groups (P > 0.05). Anatomical success rates improved over 3 months, reaching 74.0% (n = 33) for PPV versus 62.2% (n = 28) for PPV+SB. PPV achieved significantly better final BCDVA (2.71 vs. 2.84 logMAR, P < 0.05). CS increased significantly over time in the PPV group (P < 0.05) but remained stable in the PPV+SB group (P > 0.05). Although the final CS was significantly higher in the PPV+SB group compared to the PPV group (P < 0.05), this difference reflected the higher baseline values in the former group. Overall, PPV alone provided greater anatomical and functional improvement over 3 months than did the combined surgery.
Conclusions: Standalone PPV achieved higher anatomical success rates and greater visual acuity improvement over 3 months than did combined PPV+SB, while CS gains favored PPV+SB, but largely reflected higher baseline values. Despite mixed evidence in the literature, our findings suggested that PPV alone may suffice for treating selected uncomplicated RRD cases. Further large, randomized studies are needed to clarify the optimal surgical approach across different patient and RRD profiles.
Keywords:
- retinal detachments
- vitreoretinal surgeries
- vitrectomies
- scleral bucklings
- visual contrast sensitivity
- visual acuities
References
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21. Schwartz SG, Flynn HW. Pars plana vitrectomy for primary rhegmatogenous retinal detachment. Clin Ophthalmol. 2008 Mar;2(1):57-63. doi: 10.2147/opth.s1511. PMID: 19668388; PMCID: PMC2698718.
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29. Setlur VJ, Rayess N, Garg SJ, Hsu J, Luo CK, Regillo CD, Fineman MS, Sivalingam A. Combined 23-Gauge PPV and Scleral Buckle Versus 23-Gauge PPV Alone for Primary Repair of Pseudophakic Rhegmatogenous Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina. 2015 Jul-Aug;46(7):702-7. doi: 10.3928/23258160-20150730-03. PMID: 26247450.
30. Dotan A, Johnson D, Kherani A, Jahangir K, Tennant MTS. Success Rates for Retinal Detachment Repair in Alberta: A Physician Learning Program Initiative. Ophthalmologica. 2019;241(3):170-172. doi: 10.1159/000492538. Epub 2018 Oct 5. PMID: 30293073.
31. Halberstadt M, Chatterjee-Sanz N, Brandenberg L, Koerner-Stiefbold U, Koerner F, Garweg JG. Primary retinal reattachment surgery: anatomical and functional outcome in phakic and pseudophakic eyes. Eye (Lond). 2005 Aug;19(8):891-8. doi: 10.1038/sj.eye.6701687. PMID: 15389274.
32. Haugstad M, Moosmayer S, Bragad?ttir R. Primary rhegmatogenous retinal detachment - surgical methods and anatomical outcome. Acta Ophthalmol. 2017 May;95(3):247-251. doi: 10.1111/aos.13295. Epub 2016 Nov 18. PMID: 27860442.
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2. Cunha-Vaz J. The Blood-Retinal Barrier in the Management of Retinal Disease: EURETINA Award Lecture. Ophthalmologica. 2017;237(1):1-10. doi: 10.1159/000455809. Epub 2017 Feb 3. PMID: 28152535.
3. Dhande OS, Huberman AD. Retinal ganglion cell maps in the brain: implications for visual processing. Curr Opin Neurobiol. 2014 Feb;24(1):133-42. doi: 10.1016/j.conb.2013.08.006. Epub 2013 Nov 19. PMID: 24492089; PMCID: PMC4086677.
4. Ambresin A, Wolfensberger TJ, Bovey EH. Management of giant retinal tears with vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation. Retina. 2003 Oct;23(5):622-8. doi: 10.1097/00006982-200310000-00003. PMID: 14574245.
5. Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand. 2007 Aug;85(5):540-5. doi: 10.1111/j.1600-0420.2007.00888.x. Epub 2007 Mar 9. PMID: 17355251.
6. Ahmadieh H, Moradian S, Faghihi H, Parvaresh MM, Ghanbari H, Mehryar M, Heidari E, Behboudi H, Banaee T, Golestan B; Pseudophakic and Aphakic Retinal Detachment (PARD) Study Group. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation--report no. 1. Ophthalmology. 2005 Aug;112(8):1421-9. doi: 10.1016/j.ophtha.2005.02.018. PMID: 15961159.
7. Echegaray JJ, Vanner EA, Zhang L, Fortun JA, Albini TA, Berrocal AM, Smiddy WE, Flynn HW Jr, Sridhar J, Gregori NZ, Townsend JH, Davis JL, Haddock LJ. Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment. Ophthalmol Retina. 2021 Feb;5(2):169-175. doi: 10.1016/j.oret.2020.09.013. Epub 2020 Sep 25. PMID: 32980532.
8. Caiado RR, Magalhães O Jr, Badaró E, Maia A, Novais EA, Stefanini FR, Navarro RM, Arevalo JF, Wu L, Moraes N, Farah ME, Maia M. Effect of lens status in the surgical success of 23-gauge primary vitrectomy for the management of rhegmatogenous retinal detachment: the Pan American Collaborative Retina Study (PACORES) group results. Retina. 2015 Feb;35(2):326-33. doi: 10.1097/IAE.0000000000000307. PMID: 25158939.
9. Finn AP, Eliott D, Kim LA, Husain D, Wu DM, Young LH, Kim IK, Andreoli C, Skondra D, Vavvas DG, Miller JB. Characteristics and Outcomes of Simultaneous Bilateral Rhegmatogenous Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina. 2016 Sep 1;47(9):840-5. doi: 10.3928/23258160-20160901-07. PMID: 27631480.
10. Al Taisan AA, Alshamrani AA, AlZahrani AT, Al-Abdullah AA. Pars Plana Vitrectomy vs Combined Pars Plana Vitrectomy-Scleral Buckle for Primary Repair of Pediatrics Retinal Detachment. Clin Ophthalmol. 2021 May 10;15:1949-1955. doi: 10.2147/OPTH.S305910. PMID: 34007147; PMCID: PMC8121681.
11. Dimakopoulou I, Mylonas G, Iby J, Sedova A, Hollaus M, Sacu S, Georgopoulos M, Schmidt-Erfurth U. Vitrectomy versus scleral buckle for retinal detachment without posterior vitreous detachment. Sci Rep. 2024 Jul 25;14(1):17141. doi: 10.1038/s41598-024-67318-w. PMID: 39060328; PMCID: PMC11282269.
12. Znaor L, Medic A, Binder S, Vucinovic A, Marin Lovric J, Puljak L. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2019 Mar 8;3(3):CD009562. doi: 10.1002/14651858.CD009562.pub2. PMID: 30848830; PMCID: PMC6407688.
13. Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial. Retina. 2005 Dec;25(8):957-64. doi: 10.1097/00006982-200512000-00001. PMID: 16340523.
14. Bennett CR, Bex PJ, Bauer CM, Merabet LB. The Assessment of Visual Function and Functional Vision. Semin Pediatr Neurol. 2019 Oct;31:30-40. doi: 10.1016/j.spen.2019.05.006. Epub 2019 May 11. PMID: 31548022; PMCID: PMC6761988.
15. Kaur K, Gurnani B. Contrast Sensitivity. 2023 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35593849.
16. Vingopoulos F, Bannerman A, Zhou P, Koch T, Wescott HE, Kim L, Vavvas D, Miller JW, Miller JB. Towards the validation of quantitative contrast sensitivity as a clinical endpoint: correlations with vision-related quality of life in bilateral AMD. Br J Ophthalmol. 2024 May 21;108(6):846-851. doi: 10.1136/bjo-2023-323507. PMID: 37857454.
17. Sultan ZN, Agorogiannis EI, Iannetta D, Steel D, Sandinha T. Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management. BMJ Open Ophthalmol. 2020 Oct 9;5(1):e000474. doi: 10.1136/bmjophth-2020-000474. Erratum in: BMJ Open Ophthalmol. 2021 Mar 14;6(1):e000474corr1. doi: 10.1136/bmjophth-2020-000474corr1. PMID: 33083551; PMCID: PMC7549457.
18. Williams MA, Moutray TN, Jackson AJ. Uniformity of visual acuity measures in published studies. Invest Ophthalmol Vis Sci. 2008 Oct;49(10):4321-7. doi: 10.1167/iovs.07-0511. PMID: 18829857.
19. Thayaparan K, Crossland MD, Rubin GS. Clinical assessment of two new contrast sensitivity charts. Br J Ophthalmol. 2007 Jun;91(6):749-52. doi: 10.1136/bjo.2006.109280. Epub 2006 Dec 13. PMID: 17166891; PMCID: PMC1955579.
20. Puell MC, Palomo C, Sánchez-Ramos C, Villena C. Normal values for photopic and mesopic letter contrast sensitivity. J Refract Surg. 2004 Sep-Oct;20(5):484-8. doi: 10.3928/1081-597X-20040901-12. PMID: 15523961.
21. Schwartz SG, Flynn HW. Pars plana vitrectomy for primary rhegmatogenous retinal detachment. Clin Ophthalmol. 2008 Mar;2(1):57-63. doi: 10.2147/opth.s1511. PMID: 19668388; PMCID: PMC2698718.
22. Kinori M, Moisseiev E, Shoshany N, Fabian ID, Skaat A, Barak A, Loewenstein A, Moisseiev J. Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol. 2011 Aug;152(2):291-297.e2. doi: 10.1016/j.ajo.2011.01.049. Epub 2011 Jun 12. PMID: 21664592.
23. Stangos AN, Petropoulos IK, Brozou CG, Kapetanios AD, Whatham A, Pournaras CJ. Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment. Am J Ophthalmol. 2004 Dec;138(6):952-8. doi: 10.1016/j.ajo.2004.06.086. PMID: 15629285.
24. Koto T, Kawasaki R, Yamakiri K, Baba T, Nishitsuka K, Hirakata A, Sakamoto T; Japan-Retinal Detachment Registry Group. SIX MONTHS PRIMARY SUCCESS RATE FOR RETINAL DETACHMENT BETWEEN VITRECTOMY AND SCLERAL BUCKLING. Retina. 2021 Jun 1;41(6):1164-1173. doi: 10.1097/IAE.0000000000002994. PMID: 33079792.
25. Wong CW, Wong WL, Yeo IY, Loh BK, Wong EY, Wong DW, Ong SG, Ang CL, Lee SY. Trends and factors related to outcomes for primary rhegmatogenous retinal detachment surgery in a large asian tertiary eye center. Retina. 2014 Apr;34(4):684-92. doi: 10.1097/IAE.0b013e3182a48900. PMID: 24169100.
26. Ryan EH, Ryan CM, Forbes NJ, Yonekawa Y, Wagley S, Mittra RA, Parke DW, Joseph DP, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study Report Number 2: Phakic Retinal Detachment Outcomes. Ophthalmology. 2020 Aug;127(8):1077-1085. doi: 10.1016/j.ophtha.2020.03.007. Epub 2020 Mar 9. PMID: 32312634.
27. Lee IT, Lampen SIR, Wong TP, Major JC Jr, Wykoff CC. Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes. Graefes Arch Clin Exp Ophthalmol. 2019 May;257(5):883-889. doi: 10.1007/s00417-018-04236-4. Epub 2019 Jan 11. PMID: 30635720.
28. Dayani PN, Blinder KJ, Shah GK, Holekamp NM, Joseph DP, Wilson B, Thomas MA, Grand MG. Surgical outcome of scleral buckling compared with scleral buckling with vitrectomy for treatment of macula-off retinal detachment. Ophthalmic Surg Lasers Imaging. 2009 Nov-Dec;40(6):539-47. doi: 10.3928/15428877-20091030-02. PMID: 19928718.
29. Setlur VJ, Rayess N, Garg SJ, Hsu J, Luo CK, Regillo CD, Fineman MS, Sivalingam A. Combined 23-Gauge PPV and Scleral Buckle Versus 23-Gauge PPV Alone for Primary Repair of Pseudophakic Rhegmatogenous Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina. 2015 Jul-Aug;46(7):702-7. doi: 10.3928/23258160-20150730-03. PMID: 26247450.
30. Dotan A, Johnson D, Kherani A, Jahangir K, Tennant MTS. Success Rates for Retinal Detachment Repair in Alberta: A Physician Learning Program Initiative. Ophthalmologica. 2019;241(3):170-172. doi: 10.1159/000492538. Epub 2018 Oct 5. PMID: 30293073.
31. Halberstadt M, Chatterjee-Sanz N, Brandenberg L, Koerner-Stiefbold U, Koerner F, Garweg JG. Primary retinal reattachment surgery: anatomical and functional outcome in phakic and pseudophakic eyes. Eye (Lond). 2005 Aug;19(8):891-8. doi: 10.1038/sj.eye.6701687. PMID: 15389274.
32. Haugstad M, Moosmayer S, Bragad?ttir R. Primary rhegmatogenous retinal detachment - surgical methods and anatomical outcome. Acta Ophthalmol. 2017 May;95(3):247-251. doi: 10.1111/aos.13295. Epub 2016 Nov 18. PMID: 27860442.
33. Moinuddin O, Abuzaitoun RO, Hwang MW, Sathrasala SK, Chen XD, Stein JD, Johnson MW, Zacks DN, Wubben TJ, Besirli CG. Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy. BMJ Open Ophthalmol. 2021 Feb 25;6(1):e000651. doi: 10.1136/bmjophth-2020-000651. PMID: 33718613; PMCID: PMC7908907.
34. Moradian S, Ahmadieh H, Faghihi H, Ramezani A, Entezari M, Banaee T, Heidari E, Behboudi H, Yasseri M. Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial. Graefes Arch Clin Exp Ophthalmol. 2016 Sep;254(9):1743-51. doi: 10.1007/s00417-016-3318-x. Epub 2016 Mar 12. PMID: 26968718.
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