Supplemental Scleral Buckle for the Management of Rhegmatogenous Retinal Detachment by Pars Plana Vitrectomy: A Meta-Analysis of Randomized Controlled Trials

Retinal redetachment after silicone oil removal: a risk factor analysis

PURPOSE

To report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors.

METHODS

Retrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes.

RESULTS

The median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06).

CONCLUSION

A retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate.

TRIAL REGISTRATION NUMBER

ID NCT05647928 (12th April 2022).

Evaluation of Pars Plana Vitrectomy With and Without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Detachment Due to Inferior Retinal Breaks: A Systematic Review

In this systematic review, the efficacy of scleral buckle (SB) with pars plana vitrectomy (PPV) was compared to PPV alone in eyes with rhegmatogenous retinal detachment (RRD) due to inferior retinal breaks (IRB). Measured outcomes included final best-corrected visual acuity (BCVA), anatomic success, and complication rates in randomized controlled trials and observational studies from 2000 to 2022. Among four studies (696 eyes), three studies demonstrated no significant difference between PPV and PPV/SB for final BCVA, whereas one study reported better BCVA with added SB. PPV/SB yielded comparable single-surgery anatomical success (SSAS) and final anatomical success (FAS) in three studies relative to PPV alone (P < 0.05); however, one study reported better SSAS with added SB. Stratifying by lens status revealed a SSAS benefit with PPV/SB in phakic eyes (P = 0.046). No significant difference was seen in complication rates. In conclusion, PPV and PPV/SB were associated with similar functional outcomes and risk profile, whereas SSAS may be improved with PPV/SB in phakic eyes with RRD due to IRB. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study

PURPOSE

To establish whether Densiron 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment (RD) surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy (PVR).

DESIGN

Cohort study of routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal database between 2015 and 2022.

PARTICIPANTS

All consecutive eyes that underwent primary rhegmatogenous RD surgery using Densiron 68 or light silicone oil as an internal tamponade agent.

METHODS

To minimize confounding bias, we undertook 2:1 nearest-neighbor matching on inferior breaks, large inferior rhegmatogenous RDs, PVR, and, for visual analyses, baseline visual acuity (VA) between treatment groups. We fit regression models including prognostically relevant covariates, treatment-covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals (CIs) using bias-corrected cluster bootstrapping with 9999 replications.

MAIN OUTCOME MEASURES

Presence of a fully attached retina and VA at least 2 months after oil removal.

RESULTS

Of 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomic and visual outcome analyses, respectively. The primary success rate was higher in the Densiron 68 group (113 of 142; 80%) compared with the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI, 1.63-2.23, P < 0.001). We also observed a significant improvement favoring Densiron 68 of -0.26 logarithm of the minimum angle of resolution (logMAR) in postoperative VA between the 2 groups (95% CI, -0.43 to -0.10, P = 0.002). The anatomic benefit of using Densiron 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with PVR grade C. We found no evidence of visual effect moderation by anatomic outcome or foveal attachment.

CONCLUSIONS

Densiron achieved higher anatomic success rates and improved visual outcomes compared with conventional light silicone oil in eyes with inferior retinal pathology and severe PVR.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Prediction Nomogram for Recurrent Retinal Detachment

Purpose

Recurrent retinal detachment (re-RD) is one of the complications in rhegmatogenous retinal detachment patients who underwent surgical treatment. We investigated the risk factors for re-RD and developed a nomogram for estimating clinical risk.

Methods

Univariate and multivariable logistic regression models were performed to determine the association between variables and re-RD, and a nomogram was then developed for re-RD. The nomogram performance was assessed based on its discrimination, calibration, and clinical usefulness.

Results

This study analyzed 15 potential variables of re-RD in 403 rhegmatogenous retinal detachment patients who underwent initial surgical treatment. Axial length, inferior breaks, retinal break diameter, and surgical methods were independent risk factors for re-RD. A clinical nomogram incorporating these four independent risk factors was constructed. The diagnostic performance of the nomogram was excellent (area under the curve = 0.892, 95% CI: 0.831-0.953). Our study further validated this nomogram by bootstrapping for 500 repetitions. The area under the curve of the bootstrap model was 0.797 (95% CI: 0.712-0.881). This model showed good calibration curve fitting and a positive net benefit in decision curve analysis.

Conclusion

Axial length, inferior breaks, retinal break diameter, and surgical methods could be risk factors for re-RD. We have developed a prediction nomogram of re-RD for rhegmatogenous retinal detachment following initial surgical treatment.