EH Ryan, CM Ryan, NJ Forbes, et al. 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.
The Primary Retinal Detachment Outcomes (PRO) Study assessed anatomic and visual outcomes among contemporary RRD cases performed employing SB, PPV, or combined SB/PPV.
The Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment (SPR) study found that SB resulted in better visual outcomes among phakic patients. However, the SPR study was performed in 2000-2001, and since the advent of small-gauge vitrectomy in 2002, there has been an increasing trend toward repair of RRD employing PPV alone. PRO Report #2 focused on modern RRD repair (performed in 2015) outcomes among phakic patients.
From 15 sites across the United States, a total of 715 phakic patients with moderately complex primary RRD were studied. Moderately complex RRD was defined as RD extent between 3-9 clock hours, without factors that would favor one surgical approach (ie. favoring SB: age < 40; favoring PPV: presence of vitreous hemorrhage, proliferative vitreoretinopathy, giant retinal tear, prior glaucoma surgery).
The main outcomes of the study were single surgery anatomic success (SSAS) and final visual acuity. All 3 surgical approaches had good outcomes; however, the rate of SSAS was superior with SB (91.7%) and SB/PPV (91.2%), as compared with PPV (83.1%). Final attachment rates were also higher with SB (99.4%) than with PPV (96.4%) and SB/PPV (96.3%). Mean final Snellen visual acuity was superior with SB (20/30), as compared with PPV (20/44) and SB/PPV (20/43). There was a significantly greater proportion of eyes with visual outcomes of 20/200 or worse among the PPV (13.7%) and SB/PPV (13.5%) groups, as compared with the SB group (1.2%).
The takeaway point from this paper is that: in phakic patients with moderately complex, primary, rhegmatogenous retinal detachments, SB achieved better anatomic and functional outcomes, as compared with PPV and combined SB/PPV.
Brian C. Toy, MD
The USC Roski Eye Institute
Keck School of Medicine
Los Angeles, CA