Noncryopexy versus cryopexy treatment during scleral buckling: a systematic review and meta-analysis

To evaluate the differences in surgical outcomes between scleral buckling (SB) with noncryopexy and cryopexy methods.

We systematically searched the Embase, Medline, Cochrane Library, and Scopus databases for randomized controlled trials (RCTs) published from their inception until January 1, 2024. A random-effects model was applied, and outcomes are presented as risk ratios (RRs) or standardized mean differences with 95% confidence intervals (CIs). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria.

We included seven RCTs involving a total of 1103 patients. The meta-analysis revealed comparable retinal reattachment rates between noncryopexy and cryopexy methods (RR: 1.00; 95% CI: 0.96-1.05). Our subgroup analysis revealed similar results between nonretinopexy and laser retinopexy subgroups. Moreover, postoperative visual acuity (VA) and complication rates were comparable between noncryopexy and cryopexy methods (proportion of eyes with postoperative VA of 20/40 or better: RR: 1.24, 95% CI: 0.83-1.85; macular pucker: RR: 1.08, 95% CI: 0.53-2.21; cystoid macular oedema: RR: 1.01, 95% CI: 0.79-1.30; and subretinal pigmentary migration: RR: 0.34, 95% CI: 0.08-1.38). However, the certainty of evidence for these outcomes was low to very low, indicating the need for cautious interpretation of these findings.

Similar surgical outcomes were noted between noncryopexy and cryopexy methods in SB, suggesting that both methods are effective in repairing rhegmatogenous retinal detachment. However, future studies on a larger scale and with longer follow-ups may be necessary to detect late redetachment and complications.