Ophthalmol Retina. 2023 May 20:S2468-6530(23)00223-3. doi: 10.1016/j.oret.2023.05.012. Online ahead of print.
ABSTRACT
PURPOSE: To assess the risk of retinal displacement following scleral buckle (SB) versus pars plana vitrectomy with scleral buckle (PPV-SB).
DESIGN: Multi-center prospective non-randomized clinical trial.
METHODS: The study took place at VitreoRetinal Surgery in Minneapolis, USA; Sankara Nethralaya in Chennai, India and St. Michael’s Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment (RRD) with gradable post-operative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3-months post-operatively. Metamorphopsia and aniseikonia were assessed with MCHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings (RVPs) on FAF in SB vs PPV-SB.
RESULTS: Ninety-one eyes were included in this study of which 46.2%(42/91) had SB and 53.8%(49/91) underwent PPV-SB. At 3-months post-operatively, 16.7%(7/42) in the SB group and 38.8%(19/49) in the PPV-SB group had evidence of retinal displacement (difference=22.1%;odds ratio=3.2,95%CI=1.2-8.6;p=0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logMAR, lens status, and gender in a multivariate regression analysis (p=0.01). Retinal displacement was detected in 22.5%(6/27) of patients in the SB group with external subretinal fluid drainage and 6.7%(1/15) of patients without external drainage (difference=15.8%,odds ratio=4.0,95%CI=0.4-36.9;p=0.19). Mean vertical metamorphopsia, horizontal metamorphopsia and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse horizontal metamorphopsia in patients with retinal displacement vs those without retinal displacement (p=0.067).
CONCLUSIONS: SB, is associated with less retinal displacement compared to PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend towards increased risk of retinal displacement in SB eyes that underwent external drainage compared to SB eyes without drainage which is consistent with our understanding, that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse horizontal metamorphopsia at 3-months in patients with retinal displacement.
PMID:37217137 | DOI:10.1016/j.oret.2023.05.012
