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Scleral buckling remains viable for phakic eyes, study shows
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VIENNA — Scleral buckling is not "a dying art" and provides better, more stable results and fewer complications than vitrectomy in phakic eyes with rhegmatogenous retinal detachment, according to study data presented here.
Susanne Binder, MD, discussed results of the scleral buckling vs. primary vitrectomy in rhegmatogenous retinal detachment study at the joint meeting of the European Society of Ophthalmology and the American Academy of Ophthalmology.
The study involved 46 surgeons who treated 681 patients at 25 European centers. Investigators evaluated the efficacy of scleral buckling in phakic and pseudophakic patients with retinal detachment of medium severity compared with primary vitrectomy in two similar patient groups.
"We assessed the change in visual acuity, the primary success rate, the number of retina-related reoperations, final success and PVR [proliferative vitreoretinopathy] rate," Dr. Binder said.
Investigators found that vitrectomy yielded better results in aphakic eyes, but scleral buckling provided better outcomes in phakic eyes.
Phakic eyes gained one additional line of visual acuity, required fewer reoperations (40.2% vs. 66.7%) and had a much lower rate of cataract development (18.6% vs. 51%), Dr. Binder said.
Scleral buckling, therefore, should still be performed in select cases, she said, noting that the surgical technique needs to be improved and updated to involve more aspects of microsurgery. This would make the procedure more elegant, less invasive and could enhance precision and safety, she said.
"You can precisely localize the tear, do minimal cryocoagulation without affecting the blood retinal barrier, mark the tear, place the buckle into the correct position and then the fluid absorbs within 24 to 48 hours," Dr. Binder said.
Dr. Binder performed scleral buckling in a series of 114 eyes with 5 years of follow-up. No eyes experienced intraoperative complications and 85% achieved primary reattachment, with a final success rate of 99%.
Also, two-thirds of eyes achieved a visual acuity of 20/40 or better, she said.