Success Rates of Retinal Buckling Surgery: Relationship to Refractive Error and Lens Status: Results from a Large German Case Series

Primary retinopexy in preventing retinal detachment in a tertiary eye hospital: a study of 1157 eyes

PURPOSE

Retinopexy is the most common vitreo-retinal procedure performed in the eye emergency department and significantly reduces the risk of a rhegmatogenous retinal detachment (RRD). There are various indications for retinopexy, with the most common being horseshoe-tears (HST). Multiple treatment techniques exist, ranging from slit-lamp laser-retinopexy, indirect laser-retinopexy or cryopexy. We report on our primary retinopexy 6-month RRD rate, repeat retinopexy rate and compare outcomes of different indications and treatment modalities.

METHODS

Retrospective consecutive case series of 1157 patients attending Birmingham and Midlands Eye Centre, UK between January 2017 and 2020.

RESULTS

The RRD rate at 6 months was 3.9%, with 19.1% requiring subsequent retinopexies. Multivariate Cox survival regression analysis showed that significant risk factors for RRD following primary retinopexy included male gender (p = 0.012), high myopia (≤ - 6.00D, p = 0.004), HST (compared to round holes, p = 0.026) and primary cryopexy (compared to slit-lamp laser, p = 0.014). HST was the most common indication for retinopexy (812 [70.2%]) in which 118 (14.5%) had multiple tears. Slit-lamp laser was used in 883 (76.3%) of cases. The rate for subsequent epiretinal membrane peel surgery was 3 (0.3%) and was higher in eyes that required multiple retinopexy procedures (p = 0.035).

CONCLUSION

With our large cohort of patients over three years, we provide additional evidence on the RRD and subsequent retinopexy rate after primary retinopexy. Further retinopexy is a common occurrence, particularly in high-risk retinal tears such as HST. Strict monitoring and prompt follow-up after retinopexy is important to prevent progression to RRD and should be of priority in the clinicians post-retinopexy management plan, particularly in those with associated risk factors.

Scleral Buckling: A Review of Clinical Aspects and Current Concepts

Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.

Effect of deprivation and ethnicity on primary macula-on retinal detachment repair success rate and clinical outcomes: A study of 568 patients

Purpose

Socio-economic deprivation and ethnic variation have been frequently linked to poorer health outcomes. We collected a large series of primary macula-on rhegmatogenous retinal detachment (RRD) cases and analysed the effect of socio-economic deprivation and ethnicity on both six-month retinal re-detachment rate and visual outcomes.

Materials and methods

Retrospective consecutive case series of 568 patients attending Birmingham and Midlands Eye Centre from January 2017–2020. Multiple Indices of Deprivation (IMD) deciles were used for deprivation status and split to two groups: IMD-A (Decile 1–5) and IMD-B (Decile 6–10). The two largest subgroups of ethnicities were compared, White and South Asians (SA).

Results

We report an overall retinal re-detachment rate of 8.5%. IMD-A re-detached significantly more than IMD-B (11.2% vs 6.0% respectively, p = 0.034). No statistical significance was found between White and SA re-detachment rate (9.1% and 5.6% respectively, p = 0.604). SA median age significantly lower at 49 years (IQR: 37–61) compared to White patients at 57 years (IQR: 50–65) (p = <0.001). IMD-A median age of 55 years (IQR: 46–64) was significantly lower to IMD-B median age of 58 years (IQR: 51–65) (p = 0.011). No differences in final visual outcomes were detected across all groups.

Conclusion

We demonstrated an increased retinal re-detachment rate in our more deprived patients according to IMD and a younger cohort of SA compared to White ethnicity. Further prospective studies are required to demonstrate the link between socio-economic deprivation and surgical success.

Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment

Introduction

Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery.

Method

Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications.

Results

A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively.

Conclusion

Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

Success Rates for Retinal Detachment Repair in Alberta: A Physician Learning Program Initiative

OBJECTIVE

To identify primary surgical success rates for retinal detachment repair in Alberta and compare functional outcomes of methods of repair.

METHODS

Data was retrospectively extracted from the Alberta Health Services Discharge Abstract Database and the National Ambulatory Care Reporting System for all patients diagnosed with retinal detachment and vitreoretinal procedures during the 2008/09 to 2012/13 fiscal years.

RESULTS

Of the 5,433 surgeries for retinal detachment identified, 279 were excluded due to invalid provincial health numbers, unidentified procedure location, and/or treating physician other than an Alberta retina surgeon. The final analysis included 4,336 detachments in 4,020 patients. The average primary retinal detachment success rate was 84.9% (3,680/4,336). Primary success rates varied between vitrectomy only (84.9%, 2,149/2,532), vitrectomy and scleral buckle (85.5%, 818/957), and scleral buckle (84.4%, 702/832).

CONCLUSIONS

Alberta retina surgeons have an average primary success rate of 84.9% (3,680/4,336) for repair of retinal detachments. This result is in keeping with other published retinal detachment success rate studies.

Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series. J Int Med Res 2017;46:316-325. [PMID: 28840752 PMCID: PMC6011313 DOI: 10.1177/0300060517724931]

Objective

To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD).

Methods

Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA).

Results

In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40.

Conclusions

Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose

The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD).

Methods

The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age.

Results

This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003).

Conclusions

Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment

Purpose:

To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).

Design:

Retrospective interventional case series.

Materials and Methods:

Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013.

Results:

Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.

Conclusion:

Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Outcome of primary vitrectomy in phakic patients aged younger than 50 years with rhegmatogenous retinal detachments

PURPOSE

To evaluate the visual outcome, primary anatomic success, and cataract progression of phakic eyes of patients aged younger than 50 years treated for rhegmatogenous retinal detachment (RRD) with primary pars plana vitrectomy (PPV).

METHODS

This was a retrospective, observational, cross-sectional study. The data from 53 RRD patients undergoing PPV were analyzed. The time course changes in best-corrected visual acuity (BCVA) and cataract formation were examined.

RESULTS

The 53 patients had a mean age of 37.8 years. Forty-eight eyes (90.6 %) achieved anatomic success after the primary surgery. The BCVA improved significantly after surgery (mean ± SD -0.091 ± 0.146) when compared with the baseline (mean ± SD 0.214 ± 0.597; P = 0.0001). No patient aged younger than 40 years (mean 32.5 years; range 17-39) developed significant lens opacity or received cataract surgery within the first 3 years. Of the patients aged older than 40 years (mean 43.8 years; range 40-49), 22 % developed significant lens opacity and received cataract surgery within the first 3 years. A significant difference was found in cataract progression between the two groups within the first 3 years (P = 0.0217), but not over the entire follow-up period (P = 0.1679).

CONCLUSIONS

We found that lens-sparing PPV for RRD in patients aged younger than 50 years had a reasonable success rate, although cataract progression was evident during the follow-up period in patients aged older than 40 years.

Retinal Detachment Due to Retinal Dialysis: Surgical Outcome After Scleral Buckling

PURPOSE

The aim of this study was to determine the efficacy and safety of scleral buckling surgery in retinal detachment due to retinal dialysis.

DESIGN

This study was a prospective, interventional case series.

METHODS

A total of 48 eyes of 48 consecutive patients were included after obtaining informed written consent. Besides taking a thorough history, all eyes were examined by a retinal surgeon. The macula status, site, and extent of retinal dialysis and rhegmatogenous retinal detachment (RRD) were particularly noted. Proliferative vitreoretinopathy grading was done. Buckling was performed by a single surgeon. At every follow-up, visual acuity, intraocular pressure, retina status, and buckle position were noted. Any complication found was recorded. Follow-up was done for at least 6 months. SPSS version 16 was used for data analysis.

RESULTS

We included 48 cases of RRD due to retinal dialysis. The mean ± SD age of the patients was 26.85 ± 15.1 years. The macula was detached in 85.4% of the cases, and proliferative vitreoretinopathy grade C was found in 25% of the cases. A surgical reattachment rate of 95.8% was attained after a single primary buckling procedure. Final Snellen best-corrected visual acuity of 6/18 or better was attained in 12.5% of the cases. However, 62.5% of the cases had best-corrected visual acuity in the range of 6/24 to 6/60. Subretinal hemorrhage occurred in 8.3% of cases intraoperatively after subretinal fluid drainage.

CONCLUSIONS

We conclude that scleral buckling has a definite role in the management of RRD due to retinal dialysis.

Rhegmatogenous retinal detachment--an ophthalmologic emergency

BACKGROUND

Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result.

METHOD

Selective review of the literature.

RESULTS

Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved.

CONCLUSION

Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.

Short-term external buckling with pneumatic retinopexy for retinal detachment with inferior retinal breaks

PURPOSE

To introduce a new approach for short-term external scleral buckling with pneumatic retinopexy for the management of rhegmatogenous retinal detachment with inferior retinal breaks.

DESIGN

Retrospective, noncomparative, interventional case series.

METHODS

A review of 33 consecutive eyes of 31 patients who underwent external buckling with pneumatic retinopexy for uncomplicated rhegmatogenous retinal detachment with inferior retinal breaks from December 2006 through December 2010. An external buckle was made of a 505 sponge sutured along the blunt side of a 279 tyre (MIRA Inc). The buckle was inserted deeply into the inferior fornix without suture after pneumatic retinopexy and was kept in place for 3 days. Primary and final anatomic outcomes, visual acuity, and adverse events were recorded.

RESULTS

All patients tolerated the procedure. The mean follow-up period was 24.0 months (range, 9 to 61 months). Primary success, defined as successful retinal reattachment within 6 months without further treatment, was achieved in 29 (87.9%) eyes. All patients attained final retinal reattachment (100%). Overall, the mean best-corrected visual acuity improved significantly at the end of follow-up (0.30 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/12), compared with the preoperative best-corrected visual acuity (0.82 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/38; P < .001).

CONCLUSIONS

Short-term external buckling with pneumatic retinopexy is a novel and effective treatment for rhegmatogenous retinal detachment with inferior retinal breaks, with a comparable success rate with other treatment methods. This approach also can avoid complications of long-term buckle implantation. Further comparative cohort studies may be necessary to compare the clinical efficacy with other conventional operations.

[Results of scleral buckling for rhegmatogenous retinal detachment in phakic eyes]

PURPOSE

To report the results of primary scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment in phakic eyes and to determine risk factors for failure.

PATIENTS AND METHODS

Retrospective study of 100 consecutive phakic eyes undergoing surgery for uncomplicated retinal detachment. All patients underwent cryopexy, scleral buckling with hard silicone explant type 287 and in selected cases, drainage of subretinal fluid and gas tamponnade with air or SF6.

RESULTS

The primary anatomic success rate was 84% and 99% respectively after one or multiple procedures. The causes of failure were new breaks (50%), proliferative vitreoretinopathy (31.2%) and malposition of the scleral buckle (18.8%). Mean visual acuity improved from 0.77±0.75 logMar to 0.21±0.19 logMar (P<0.00001). Predictive risk factors for failure included extent of the detachment beyond one quadrant and multiple breaks (P=0.03). Horseshoe tears had a worse prognosis than oral dialysis or atrophic round holes (P=0.04).

CONCLUSION

Scleral buckling remains safe and effective for the treatment of uncomplicated rhegmatogenous retinal detachments in phakic eyes, especially when the extent of the detachment was less than one quadrant or in the presence of a single tear, an atrophic round hole or an oral dialysis.