Types of strabismus and strabismus surgery after retinal detachment repair: a health registry database analysis

To examine the rate of diplopia, strabismus, and interventions for strabismus after pneumatic retinopexy, scleral buckle, and pars plana vitrectomy with and without scleral buckle for primary repair of rhegmatogenous retinal detachment (RRD).

This retrospective cohort study draws on deidentified EHR data of over 126 million patients in the TriNetX Analytics platform, a federated health research network. Subjects were assigned to three cohorts: pneumatic retinopexy (PR) alone, scleral buckle (SB) alone, or pars plana vitrectomy with or without scleral buckle (PPV+/-SB). Univariate analyses and propensity score matching (PSM) sensitivity analyses were conducted. Main outcomes were the risk of diplopia, strabismus, sensorimotor examination, or strabismus interventions, including chemodenervation or surgery. Kaplan-Meier analysis was performed.

A total of 25,169 subjects were identified: PR (n = 1,646), SB (n = 3,658), and PPV+/-SB (n = 19,865). SB had the highest rates of diplopia (2.73%) and strabismus (1.79%), followed by PPV+/-SB (diplopia, 2.28%; strabismus, 1.46%) and PR (diplopia, 1.54%; strabismus, 0.612%). SB and PPV+/-SB had a significantly higher risk of diplopia (P < 0.01) and strabismus (P < 0.001) compared to PR. No significant differences were observed between PPV+/-SB and SB (P = 0.106 and P = 0.139). Kaplan-Meier analysis indicated SB had the highest hazard during the first year after surgery. Strabismus interventions were rare, with surgery in ≤0.27% of the SB cohort, 0.22% of the PPV+/-SB cohort, and ≤0.61% of the PR cohort. No subjects underwent chemodenervation.

The risk of diplopia and strabismus after RRD treatments is low. SB carries the highest risk, followed by PPV+/-SB and PR. These findings support informed decision making in selecting RRD repair techniques.