Outcomes of Scleral Buckling in Paediatric Rhegmatogenous Retinal Detachment: The Manchester Buckle Study

Objectives: To describe the anatomical and functional outcomes of paediatric rhegmatogenous retinal detachment (RRD) managed primarily with scleral buckle and to identify factors predicting single-surgery anatomical success (SSAS) and postoperative best-recorded visual acuity (BRVA). Methods: A retrospective review was conducted of 49 patients (≤18 years) who underwent primary scleral buckle for RRD between 2008 and 2023 at the Manchester Royal Eye Hospital. Data on patient and RRD characteristics, ocular comorbidities, surgical technique, complications, and postoperative outcomes were collected. SSAS, final anatomical success, and BRVA were assessed. Results: The mean age at surgery was 12 ± 3 years, with macula-off detachment in 57% (28/49). SSAS after scleral buckle surgery was achieved in 71% (35/49). At the second surgery, 13 out of 14 patients underwent vitrectomy, and one patient had repeat scleral buckling. The final anatomical success rate was achieved in 96% (47/49). On multivariable analysis, older age independently predicted higher odds of SSAS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.05-1.91, p = 0.023), whereas macula status, drainage, and trauma were not independent predictors. In a multivariable linear model for postoperative BRVA (logMAR), older age was associated with better BRVA (B = -0.162, 95% CI -0.244 to -0.080, p < 0.001), and macula-off status with worse BRVA (B = 0.520, 95% CI 0.022 to 1.018, p = 0.041); drainage and trauma were not significant. Conclusions: Primary scleral buckle, with secondary vitrectomy if needed, is effective for paediatric RRD, yielding a 71% SSAS and 96% final anatomical success. Older age was independently associated with higher SSAS and better postoperative BRVA, while macula-off presentation was associated with worse postoperative BRVA.