Supplemental scleral buckle for the management of rhegmatogenous retinal detachment by pars plana vitrectomy: A meta-analysis of randomized controlled trials

Abstract

Objectives: The present review aims to synthesize evidence from randomized controlled trials (RCTs) that compared outcomes of pars plana vitrectomy (PPV) with and without a supplementary scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD). Methods: The authors searched MEDLINE, EMBASE, and CENTRAL to identify RCTs in English that compared PPV with and without supplemental SB. Risk of bias was assessed according to Cochrane Risk of Bias 2 tool. We present risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) estimated using random effects meta-analyses. Results: We identified six RCTs involving 705 eyes. Primary reattachment (6 studies, 345 eyes PPV, 324 eyes PPV+SB; RR 0.99, 95% CI 0.93-1.06, I2 = 0%, p = 0.78) and final anatomic success rates (4 studies, 272 eyes PPV, 267 eyes PPV+SB; RR 1.00, 95% CI 0.98-1.02, I2 = 0%, p = 0.89) were similar between the two groups. Postoperative visual acuity improvement (5 studies, 244 eyes PPV, 222 eyes PPV+SB; MD 6.09 letters, 95% CI -0.47-12.64, I2 = 69%, p = 0.07) and frequency of adverse events (6 studies, 1294 observations PPV, 1221 observations PPV+SB; RR 0.76, 95% CI 0.57-1.01, I2 = 25%, p = 0.06) likewise did not differ significantly between the treatment groups. Conclusion: Low-certainty evidence from RCTs did not demonstrate a benefit in placement of a supplemental scleral buckle during vitrectomy for management of RRD in the current analysis. Additional high-quality trials are needed to provide more precise estimates of effect.