Study: Better reattachment rate with macular buckling vs. PPV for retinal detachment

Episcleral macular buckling led to higher rates of retinal reattachment and better visual outcomes over pars plana vitrectomy in highly myopic eyes with retinal detachment caused by macular holes, a study found.

Fumitaka Ando, MD, and colleagues in Nagoya, Japan, retrospectively compared the surgeries in a series of patients matched at baseline for age, sex, refractive error and degree of retinal detachment. All patients had high myopia, posterior staphyloma and geographic chorioretinal atrophy, according to the study authors.

Thirty eyes of 30 patients underwent posterior episcleral macular buckling (EMB), during which surgeons implanted a solid silicone plate specifically designed for macular indentation. Pars plana vitrectomy (PPV) with fluid-gas exchange was performed on 28 eyes of 28 patients.

The researchers found that EMB successfully reattached retinas in 93.3% of patients after the primary surgery. After a subsequent surgery, the reattachment rate improved to 100%. In contrast, only 50% of cases were reattached after undergoing primary PPV, and secondary EMB surgery improved the reattachment rate to 86% in these cases, according to the study authors.

The results indicate a "better anatomical success rate after primary EMB than after primary PPV," they said.

Optical coherence tomography, which had been performed in 12 EMB-treated eyes, showed that 10 eyes had complete macular hole closure and retinal reattachment. The other two eyes had persistent reattachment with the foveal defect, according to the study. At an average 52.8 months' follow-up, mean logMAR visual acuity for the EMB-treated group had significantly increased to 0.92 from 1.45 preoperatively (P < .001) and was significantly greater than the improvement seen for the PPV group (P < .005), the authors noted.

The study is published in the January issue of Retina.