Scleral Buckling without PPV Effective for Patients with Retinal Dialysis

Harry W Flynn Jr., MD

Credit: Bascom Palmer Eye Institute

Retinal detachment associated with retinal dialysis is typically associated with trauma, and retinal detachment is a more common occurrence in young, male patients.¹

In this analysis, investigators, led by Harry W Flynn Jr., MD, department of ophthalmology, Bascom Palmer Eye Institute, aimed to report the surgical approaches and outcomes in patients undergoing surgery for retinal detachment associated with retinal dialysis, including scleral buckling and pars plana vitrectomy (PPV).

Results from the analysis showed scleral buckling alone had a single operation success rate of 76.9%, compared to a single operation success rate of 77.8% for scleral buckling plus PPV.

“The current study confirms that scleral buckling without PPV is an effective initial treatment strategy for most patients with retinal dialysis and has a low rate of cataract formation,” Flynn and colleagues wrote.

Retinal dialysis, the disinsertion of the retina from the vitreous base, is an uncommon cause of retinal detachment, accounting for approximately 8% to 17% of detachments.² It is most common in young people following trauma but is additionally a hereditary source of retinal dialysis. Vitrectomy is a common method for repairing retinal detachment associated with giant retinal tears, while scleral buckling alone may be sufficient for patients with retinal dialysis, despite rates being on the decline.

This retrospective, consecutive case series included all patients who underwent surgery for retinal detachment secondary to retinal dialysis between January 2012 and January 2022.¹ The main outcomes for the analysis included best-corrected visual acuity (BCVA) and single-operation success rate. The study cohort included a total of 60 eyes of 58 patients, with an average age of 26.4 years. A total of 49 (84.5%) patients were male, and known trauma occurred in 35 (61.4%) cases.

According to the analysis, internal surgical management included scleral buckling in 49 (81.7%) eyes and combined scleral buckling and PPV in 11 (18.3%) eyes. The preoperative BCVA correlated with BCVA at the last follow-up visit (r = –0.66; P <.001).

At the last visit, the scleral buckling group had a mean logarithm of the minimum angle of resolution BCVA of 0.36 (n = 20 of 46) and a single-operation success rate of 76.9% at 6 months (P = .04). On the other hand, the scleral buckling and PPV group had a mean logarithm of the minimum angle of resolution BCVA of 1.08 (n = 20 of 238) and a single-operation success rate of 77.8% (P = .96)

A total of 6 eyes in the scleral buckling and PPV group received silicone oil tamponade. In eyes with ≥1 year of follow-up, 4 (14.8%) in the scleral buckling group and 6 (100%) in the scleral buckling and PPV group developed a visually significant cataract requiring cataract surgery (P <.001).

“Retinal detachment associated with retinal dialysis is typically associated with trauma and more often occurs in young male patients,” investigators wrote.

References

1. _{Rohowetz LJ, Jabbehdari S, Smiddy WE, et al. Retinal Detachment Associated with Retinal Dialysis: Clinical Features and Outcomes of Surgery in a 10-Year Study. Ophthalmol Retina. 2023;7(10):857-861. doi:10.1016/j.oret.2023.06.013}
2. _{Chang JS, Marra K, Flynn HW Jr, Berrocal AM, Arroyo JG. Scleral Buckling in the Treatment of Retinal Detachment Due to Retinal Dialysis. Ophthalmic Surg Lasers Imaging Retina. 2016;47(4):336-340. doi:10.3928/23258160-20160324-06}