Author: Prem Nichani (Canada)
Co-authors: Arjan S. Dhoot, Arshia Eshtiaghi, Aman P. Sayal, Marko M. Popovic, Rajeev H. Muni, Peter J. Kertes
Rhegmatogenous retinal detachment (RRD) can be managed via scleral buckling (SB) alone or in combination with pars plana vitrectomy (PPV+SB). This meta-analysis aims to elucidate the comparative efficacy and safety of these commonly used surgical procedures.
Systematic review and meta-analysis.
We conducted a systematic literature search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from January 2000 to June 2020. English-language, peer-reviewed, comparative randomized controlled trials (RCTs) and observational studies reporting on the efficacy and/or safety outcomes of SB in comparison to PPV+SB in eyes with RRD were included. Critical appraisal was performed using Cochrane risk of bias 2 tool for RCTs and the ROBINS-I tool for observational studies. GRADE guidelines were used to assess the certainty of evidence. The primary endpoint was final best corrected visual acuity (BCVA). Secondary outcomes were primary and final reattachment rates and the incidence of ocular adverse events. All outcomes were collected at last follow-up. Random effects meta-analyses were conducted for all outcomes. Categorical outcomes were reported as risk ratios (RR) and continuous outcomes were reported as weighted mean differences (WMD). A 95% confidence interval (CI) was calculated in all analyses and a p-value less than 0.05 was considered significant. Number needed to treat (NNT) and number needed to harm (NNH) were also reported.
Across 13 studies, 6715 baseline eyes (3247 SB and 3468 PPV+SB) were included. Compared to PPV+SB, SB alone achieved a significantly better final BCVA (0.29 ± 0.46 vs. 0.51 ± 0.58 logMAR, respectively; WMD, –0.17 logMAR; 95%CI, –0.30 to –0.04; P=0.007; GRADE: moderate certainty of evidence) and final reattachment rate (98.1% vs. 95.2%, respectively; RR, 1.02; 95%CI, 1.01 to 1.04; P=0.001; NNT, 50; GRADE: high certainty of evidence). However, the primary reattachment rate was similar between PPV+SB and SB (87.2% vs. 88.1%, respectively; RR, 0.99; 95%CI, 0.94 to 1.03; P=0.54; GRADE: moderate certainty of evidence). Eyes with SB alone had a significantly lower risk of cataract development or progression compared with PPV+SB (7.3% vs. 32.8%, respectively; RR, 0.28; 95%CI, 0.22 to 0.36; P<0.00001; NNH, 4; GRADE: moderate certainty of evidence). There were no significant differences between SB alone and PPV+SB in the incidence of epiretinal membrane formation (P=0.53), macular edema (P=0.62), elevated intraocular pressure (IOP; P=0.66), and development or progression of proliferative vitreoretinopathy (PVR; P=0.36).
Compared to PPV+SB, SB alone offers significantly better final BCVA and final reattachment rate along with reduced risk of cataract development or formation in RRD eyes (GRADE: high certainty of evidence). The primary reattachment rate and the incidence of epiretinal membrane formation, macular edema, elevated IOP, and development or progression of PVR were similar between SB alone and PPV+SB (GRADE: low-moderate certainty of evidence).
Conflicts of Interest: PN: None. ASD: None. AE: None. APS: None. MMP: Financial support (to institution) - PSI Foundation PJK: Consultant – Novartis, Alcon, Bayer, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx. RHM: Consultant – Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.