Surgical Management of Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachment (RRD) is a common ophthalmic emergency, with an annual incidence of 7.9 to 18.2 cases per 100,000 individuals. Caused by a retinal tear, this condition can lead to blindness without prompt and appropriate intervention. Surgery remains the cornerstone of treatment, but the optimal choice among available options is still debated. This study provides a comparative evaluation of the main surgical approaches, including pars plana vitrectomy (PPV), scleral buckling (SB), pneumatic retinopexy (PR), and their combinations.

Which surgical strategies maximize success in treating retinal detachment?

The analysis is based on 19 randomized controlled trials involving a total of 2,589 eyes. Techniques were assessed using three primary criteria: the rate of retinal reattachment, best-corrected visual acuity (BCVA) at six months, and postoperative complications. Results first reveal that PPV combined with phacoemulsification (PCV) achieves the highest retinal reattachment rate, followed by the combination of PPV and SB. SB alone proves more effective than PR but is less successful than PPV.  

In terms of postoperative visual acuity, SB shows significantly better outcomes compared to the PPV+SB combination.  

Finally, regarding postoperative complications, cataract progression is more frequently observed with PPV and the PPV+SB combination compared to SB and PR.

Retinal detachment: toward personalized treatment approaches

This study highlights the strengths and limitations of each surgical approach. While PPV combined with other techniques improves the retinal reattachment rate, it also increases the risk of complications such as postoperative cataract formation, necessitating closer follow-up. Conversely, SB remains an effective and less invasive option, particularly suitable for cases without complex comorbidities. These findings underscore that the choice of surgical technique should be guided by the individual patient profile and the specific characteristics of the retinal detachment.