This article is more than 5 years old. Information may no longer be current.
Despite increased use of vitrectomy, scleral buckling still has a role, surgeon says
Click Here to Manage Email Alerts
NUREMBERG, Germany — Until studies show primary vitrectomy to be a superior surgical intervention, scleral buckling procedures will continue to play an important role in treating retinal detachment, according to a surgeon speaking here at the German Ophthalmic Surgeons meeting.
M. H. Foerster, MD, said the use of scleral buckling has declined since the introduction of vitrectomy, mainly because the latter procedure has been associated with fewer complications, such as scleral necrosis, motility disorders and changes in refraction. He said effective buckling requires proper patient selection and is highly dependent on surgical skill, making the procedure time-consuming.
Dr. Foerster noted that the technique has not changed much since its introduction, and success rates have also not improved. He said 5% of eyes after buckling have no function or complete functional loss despite revision, and only half of eyes will achieve reading vision postoperatively. In contrast, vitrectomy, which is increasingly being taught to vitreoretinal surgeons, is much faster and less skill-intensive.
Other advantages of primary vitrectomy include better control, the ability to remove nuclear opacities immediately, and the ability to identify foramen and macular holes easily, Dr. Foerster said. An external drainage site, which might result in choroidal hemorrhage, is also not required, he said.
However, he noted that buckling procedures have a long history of use and require few surgical devices, making surgical costs quite low. Also, because it is not an intraocular procedure, there is less risk for cataract formation.
“What has not been clarified yet is the primary success rate, final success rate, functional results, [proliferative vitreoretinopathy] rates, macular pucker and overall costs, which we need to take into consideration,” Dr. Foerster said. “Only a few studies deal with the long term results [of vitrectomy].”
Vitrectomy seems to have become the technique of choice, he said, perhaps because buckling surgery “has a long learning curve and is hardly ever taught in our universities today.”
“I think, though, that it will still play a role in the future. It will not become obsolete,” Prof. Foerster said.