Author: Arjan Dhoot (Canada)
Co-authors: Marko Popovic, Prem Nichani, Arshia Eshtiaghi, Aman Sayal, Peter Kertes, Rajeev Muni
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachments (RRD). This meta-analysis aimed to compare the efficacy and safety for PPV and SB in RRD repair.
Systematic review and meta-analysis.
A systematic literature review was performed using Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from January 2000 to June 2020. Randomized controlled trials (RCTs) and observational studies reporting on the efficacy and/or safety of PPV and SB for the primary surgical management of RRDs were included. Categorical outcomes were reported as risk ratios (RR) and continuous outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CI). A random effects model was used for all analyses. Number needed to treat (NNT) and number needed to harm (NNH) were reported. Risk of bias assessment was conducted with the Cochrane criteria for RCTs and the ROBINS-I tool for observational studies. The primary outcome was final best corrected visual acuity (BCVA). Secondary outcomes were primary and final reattachment rates and the incidence of adverse events.
Across 38 studies, 5225 SB and 9473 PPV eyes were included. Median final follow up was 6 months (range: 1–60). Final BCVA significantly favored SB over PPV (WMD, 0.06 logMAR; 95%CI, 0.01 to 0.11]; P=0.03). Compared to SB, PPV was associated with a higher incidence of cataracts (10.4% vs. 39.8%, respectively; RR, 3.48; 95%CI, 2.48 to 5.16; P<0.00001; NNH, 4) and iatrogenic breaks (0.5% vs. 7.9%, respectively; RR, 6.58; 95%CI, 2.98 to 14.52; P<0.00001; NNH, 12.5). However, PPV was associated with a lower incidence of subretinal/choroidal hemorrhage (0.6% vs. 5.5%, respectively; RR, 0.24; 95%CI, 0.09 to 0.67; P=0.0007; NNH, 20), choroidal detachment (0% vs. 4.1%, respectively; RR, 0.14; 95%CI, 0.04 to 0.54; P=0.004; NNH 12.5), and residual subretinal fluid (3.6% vs. 28.4%, respectively; RR, 0.18; 95%CI, 0.10 to 0.35; P<0.00001; NNH 3.85) compared to SB. PPV and SB had similar primary (86.2% vs. 85.0%, respectively; P=0.62) and final (96.7% vs. 97.8%, respectively; P=0.10) reattachment rates. There were no significant differences in operation time (P=0.52) and adverse event rates including diplopia (P=0.24), anterior chamber inflammation (P=0.27), elevated intraocular pressure (P=0.13), ocular hypertension (P=0.19), iris capture (P=0.84), proliferative vitreoretinopathy development (P=0.81), macular edema (P=0.86), macular hole (P=0.59), and epiretinal membrane formation (P=0.48).
For RRD repair, SB was associated with a better final BCVA compared to PPV. Primary and final reattachment rates were similar between the two procedures. PPV was favored for reduced choroidal detachment, choroidal/subretinal hemorrhage, and residual subretinal fluid while SB was favored for fewer iatrogenic breaks and reduced cataract formation
AD: None, MP: Financial support (to institution) - PSI Foundation, AE: None, AS: None, PN: None, PK: Consultant – Novartis, Alcon, Bayer, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx RM: Consultant – Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.