Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada,
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ophthalmologica. 2022;245(4):296-314. doi: 10.1159/000524888. Epub 2022 May 9.
The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB + PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear.
A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB + PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated.
Across 18 studies, 3912 SB and 3300 SB + PPV eyes were included. Final BCVA was nonsignificantly different between SB and SB + PPV (20/38 vs. 20/66 Snellen; WMD = -0.11 LogMAR; 95% CI: [-0.29, 0.07]; p = 0.23). Primary reattachment rate was similar between procedures (p = 0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR = 1.03; 95% CI: [1.00, 1.06]; p = 0.04). Compared to SB + PPV, SB alone had a significantly lower risk of postoperative macular edema (RR = 0.69; 95% CI: [0.47, 1.00]; p = 0.05) and cataract formation (RR = 0.34; 95% CI: [0.12, 0.96]; p = 0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB + PPV.
There was no significant difference in final BCVA between SB + PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.
巩膜扣带术（SB）与 SB 联合玻璃体切除术（SB + PPV）治疗孔源性视网膜脱离（RRD）的疗效和安全性尚不清楚。
系统检索 2000 年 1 月至 2021 年 6 月发表的比较 SB 和 SB + PPV 治疗 RRD 修复后疗效和/或安全性的研究。最终最佳矫正视力（BCVA）为主要终点，视网膜再附着率和眼部不良事件为次要终点。采用随机效应荟萃分析，并计算 95%置信区间。
共纳入 18 项研究的 3912 只 SB 眼和 3300 只 SB + PPV 眼。SB 和 SB + PPV 之间最终 BCVA 无显著差异（20/38 与 20/66 Snellen；WMD=-0.11 LogMAR；95%CI：[-0.29，0.07]；p=0.23）。两种手术的主要再附着率相似（p=0.74）；然而，SB 单独治疗的最终再附着率显著更高（97.40%与 93.86%；RR=1.03；95%CI：[1.00，1.06]；p=0.04）。与 SB + PPV 相比，SB 单独治疗的术后黄斑水肿（RR=0.69；95%CI：[0.47，1.00]；p=0.05）和白内障形成（RR=0.34；95%CI：[0.12，0.96]；p=0.04）风险显著降低。SB 和 SB + PPV 之间黄斑裂孔、视网膜前膜、残余视网膜下液、增生性玻璃体视网膜病变、眼内压升高和眼外肌功能障碍的发生率相似。
在 RRD 中，SB + PPV 与 SB 单独治疗的最终 BCVA 无显著差异。SB 单独治疗可提高最终再附着率，并降低黄斑水肿和白内障的风险。两种手术的主要再附着率和其他并发症的发生率相似。
