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Clin Ophthalmol. 2018 Aug 30;12:1605-1615. doi: 10.2147/OPTH.S153717. eCollection 2018.

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives.

Park SW1,2, Lee JJ1,2, Lee JE1,2.

Author information

1
Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea, jlee@pusan.ac.kr.
2
Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea, jlee@pusan.ac.kr.

Abstract

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

KEYWORDS:

age; myopia; posterior vitreous detachment; rhegmatogenous retinal detachment; scleral buckling; vitreous

Conflict of interest statement

Disclosure Lee JE is a consultant for Allergan, Bayer, and Novartis, and received honorarium from Alcon, Allergan, Bayer, and Novartis. The other authors report no conflicts of interest in this work.

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