Risk factors of retinal non-reattachment after initial buckling surgery for rhegmatogenous retinal detachment

Non-reattachment of the retina following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) is a cause of poor visual prognosis. We investigated the incidence of non-reattachment after primary SB alone for RRD and its risk factors.

Retrospective single-center study.

Overall, 497 eyes (472 patients; age: 31.4±14.1 years; 308 men [65.3%]) which underwent primary scleral buckling with a silicone sponge exoplant for rhegmatogenous retinal detachment (RRD) between January 2011 and March 2019 were included and classified into non-reattachment and reattachment groups. Age, sex, time from onset to initial surgery, intraocular lens-implanted eye, axial length, preoperative visual acuity, preoperative intraocular pressure, macular detachment, detachment extent, number/location of retinal breaks, surgeon, number of retinal cryopexies, and operative time were used for univariate analysis, followed by multivariate analysis for factors with significant group differences on univariate analysis.

Among 497 eyes, 32/465 were classified into the non-reattachment/reattachment groups, respectively. The initial repositioning rate was 93.6%. The non-reattachment group had a higher proportion of temporal retinal breaks (46.9% vs. 28.2%; p=0.04) and a lower proportion of inferior retinal breaks than the non-reattachment group (21.9% vs. 45.0%; p=0.02). On age- and sex-adjusted multivariate analysis, inferior retinal break was associated with a reduced risk of non-reattachment (likelihood ratio: 4.09; odds ratio: 0.41, confidence interval: 0.15-0.97).

The initial reattachment rate for SB surgery for RRD was high, and no risk factors for non-reattachment were identified. However, a favorable outcome was more likely for inferior retinal breaks than breaks in other quadrants.