Abstract
Purpose :
Recent advancements in surgical instrumentation have shifted physician preference toward use of PPV for treatment of primary RRD. Placement of a supplemental buckle, however, remains the subject of intense debate. The present review aims to synthesize evidence from randomized controlled trials (RCTs) that compared efficacy and safety of pars plana vitrectomy (PPV) with and without application of a supplementary scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD).
Methods :
The authors searched MEDLINE, EMBASE, and CENTRAL on July 2, 2020 from their inception to identify RCTs published in English that compared safety and efficacy of PPV with and without supplemental SB. Risk of bias was assessed according to Cochrane Risk of Bias 2 tool. We present risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) estimated using random effects meta-analyses.
Results :
We identified six eligible RCTs (705 eyes). Primary reattachment (6 studies, 345 eyes PPV, 324 eyes PPV+SB; RR 0.99, 95% CI 0.93-1.06, I2 = 0%, p = 0.78) and final anatomic success rates (4 studies, 272 eyes PPV, 267 eyes PPV+SB; RR 1.00, 95% CI 0.98-1.02, I2 = 0%, p = 0.89) were similar between groups. Postoperative improvement in visual acuity (5 studies, 244 eyes PPV, 222 eyes PPV+SB; MD 6.09 letters, 95% CI -0.47-12.64, I2 = 69%, p = 0.07) and frequency of adverse events (6 studies, 1294 observations PPV, 1221 observations PPV+SB; RR 0.76, 95% CI 0.57-1.01, I2 = 25%, p = 0.06) likewise were not found to differ significantly between treatment arms.
Conclusions :
Low-certainty evidence from RCTs did not demonstrate a benefit in placement of a supplemental scleral buckle during vitrectomy for management of RRD. Additional high-quality trials are needed to provide more precise estimates of effect.
This is a 2021 ARVO Annual Meeting abstract.