Surgical managements for rhegmatogenous retinal detachment: A network meta-analysis of randomized controlled trial

Rhegmatogenous retinal detachment (RRD) is the most common ophthalmic emergency threatening vision, with an incidence ranging from 6.3 to 17.9 per 100,000 people per year. However, optimal surgical management of RRD remains controversial. This network meta-analysis compared the efficacy and safety of different surgical options in patients with RRD.

We systematically searched PubMed, Embase, Cochrane Library and Web of science for randomized controlled trials (RCT) from inception to 24th September 2023. Frequentist network meta-analyses with the random-effects model was used to synthesize data. The risk of bias for the included RCTs was evaluated using the Cochrane tool for assessing risk of bias, and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. And we performed the network meta-analysis utilizing R 4.1.3 software and Stata 16SE.

A total of 19 RCTs enrolled 2589 eyes were included. With high-to-very low certainty of evidence, compared with pneumatic retinopexy (PR), scleral buckling (SB) (odd ratio (OR) = 0.52, 95% confidence interval (CI) [0.30; 0.91]), pars plana vitrectomy (PPV) (OR = 2.35, 95% CI [1.32; 4.20]), PPV+SB (OR = 2.59, 95% CI [1.32; 5.09]) and PPV combined with phacomulsification (PCV) (OR = 7.72, 95% CI [1.07; 55.87]) were more effect in improving primary reattachment rate; for postoperative 6-month vision, SB was superior to PPV+SB (mean difference (MD) = 0.14, 95% CI [0.01; 0.27]). When compared with SB, PPV (OR = 5.27, 95% CI [3.13; 8.86]) and PPV+SB (OR = 10.12, 95% CI [4.31; 23.77]) shows a higher incidence of postoperative cataract progression. Compared to PR, the same is true for PPV (OR = 7.51, 95% CI [3.33; 16.91]) and PPV+SB (OR = 14.43, 95% CI [4.97; 41.93]).

PR appears to be associated with a lower rate of primary reattachment rate and postoperative cataract progression. In view of the small sample sizes of the included studies and the low certainty of evidence, these findings must be interpreted with caution. A large number of high-quality trials should be conducted to verify the effects of different surgical techniques in the future.