Outcomes and predictive factors in scleral buckle surgery for rhegmatogenous retinal detachments

Over the last 25 years, there has been a shift away from ab externo scleral buckling to vitrectomy and internal tamponade for the repair of rhegmatogenous retinal detachments (RRD). Despite this, there are still specific indications for scleral buckle. There is little recent research on which patient and surgical factors influence the success or failure of buckle surgery for RRDs.

A review of 1015 eyes in the BEAVRS/Euretina database treated by a scleral buckle between January 2011 and September 2022. Demographics, characteristics of the RRD, and details of the buckling procedure were assessed to determine which factors were associated with surgical success. Success was defined as an attached retina with a minimum follow up of 6 weeks. Potential risk factors were analysed by multivariable logistic regression.

54.4% of the patients were male, and the median patient age was 37. The single operation success rate was 87.5%. Factors associated with an increased risk of failure include the presence of a U-tear, compared to a round hole or dialysis (OR 3.18, p < 0.001), PVR B or C (OR 2.07, p = 0.03), involvement of more than one quadrant (OR 2.03, p = 0.007), lowest break above midline (OR 1.68, p = 0.03), age (OR 1.02 per year, p = 0.007). A reduced risk of failure was associated with: surgery performed by a high volume surgeon (defined as ≥ 45 buckle procedures; OR 0.62, p = 0.027), the use of a sponge (OR 0.47, p = 0.002), macula on detachment (0.61, p = 0.03) and performing stab needle drainage (OR 0.41, p = 0.001). In patients under 40, with detachments caused by round holes or retinal dialysis, the retina was reattached with a single operation in 91.1% of eyes.

We identified patient and surgical variables which are associated with buckle failure. This study confirms that, scleral buckle procedures still have a role in treating RRD. Sub-retinal fluid drainage, and use of a sponge rather than a silicone tyre, may increase the probability of surgical success.