Acute Retinal Necrosis Associated Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis

To evaluate the success of surgical management for rhegmatogenous retinal detachment (RRD) secondary to acute retinal necrosis (ARN).

PubMed, Embase, ClinicalTrials, the Cochrane Library, and grey literature (2000-present) were searched for case series, interventional, and cohort studies reporting surgical repair of ARN-related RRD. Interventions included pars plana vitrectomy (PPV), scleral buckle (SB), and tamponade agents. Outcomes were final anatomical reattachment, visual acuity (VA), complications, and re-detachment. Study quality was assessed using the Newcastle-Ottawa Scale. A single-arm random-effects meta-analysis with subgroup analysis by surgical technique was performed using R.

Twenty-three studies including 770 eyes of 680 patients were analyzed. The pooled anatomical success rate was 88% (95% CI: 79-95%), highest with PPV + SB (91%, 95% CI: 45-100%), followed by PPV + silicone oil (83%, 95% CI: 59-99%). The pooled final VA was 1.36 logMAR (95% CI: 1.18-1.54). PPV + SB achieved the best visual outcomes (0.87 logMAR, 95% CI: 0.47-1.27), while PPV + gas tamponade had the poorest (1.75 logMAR, 95% CI: -0.73-4.23); surgical technique significantly affected final VA (p = 0.028). Common complications included proliferative vitreoretinopathy (65%), optic atrophy (53%), retinal re-detachment (25%), and cataract (38%). Poorer preoperative VA was significantly associated with worse postoperative VA (p = 0.026).

Surgical repair of ARN-related RRD yields high anatomical success, but visual recovery remains limited and technique-dependent. Combined PPV + SB provides the most favorable structural and functional outcomes without increased complication risk, supporting its preferential use.