Category: Clinical

Month: 16 May 2019

Issue: not yet available

A Cochrane systematic review identifies pars plana vitrectomy vs scleral buckling repair for rhegmatogenous retinal detachments

A Cochrane comprehensive study has confirmed that there is a low, or very low, certainty evidence indicating that “there may be little or no difference between PPV (pars plana vitrectomy) and scleral buckling in terms of primary success rate, visual acuity gain and final anatomical success in treating primary RRD (rhegmatogenous retinal detachment)”.  The Cochrane study reviewed 10 relevant studies with 1,307 participants from Europe, India, Iran, Japan and Mexico, and all studies were compared scleral buckling with PPV alone or combined with scleral buckling for treating RRD.  While the results of the review show that there is little or no difference between PPV and scleral buckling, PPV was associated with lower rates of retinal redetachment compared to scleral buckling (low-certainty evidence).

 

Regardless to the little or no difference comparison between the techniques under the study, surgeons disagree on which therapeutic approach (PPV or scleral buckling) is the best primary retinal reattachment option. Consequently, a systematic review of the efficacy of these treatments may be useful to ophthalmologists and patients with RRD. Historically, scleral buckling was the only surgical option to be used as the gold standard for primary RRD with a single break, limited retinal detachment and good visibility.  Initially, PPV used to be considered as high-risk surgery however, from about 1999 in some centres, the technique gained in popularity and today the surgical procedure seems to be a preference choice.  The current Cochrane review has commented that, “most surgeons would agree that PPV is usually the surgical method of choice for the repair of complex RRD (giant retinal tears, vitreous haemorrhage, breaks at the posterior pole or RRD associated with PVR) on one hand, and scleral buckling and pneumatic retinopexy for the repair of RRD with good visibility of the fundus, single breaks or limited retinal detachments on the other hand”.

 

The results of the Cochrane review found that five studies were funded by non-commercial sources, while the other five studies did not report source of funding. There was little or no difference in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16.  A standard forest plot of comparison between pars plana vitrectomy (PPV) vs scleral buckling on a primary retinal reattachment rate at least 3 months after operation was represented in the systematic review. There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10.  Furthermore, there was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR1.01, 95% CI 0.99 to 1.04. There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.

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