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Scleral buckling or vitrectomy for primary retinal detachment up to surgeon preference

Carl D. Regillo

WAIKOLOA, Hawaii — Whether to perform scleral buckle alone or add it to pars plana vitrectomy in cases of primary rhegmatogenous retinal detachment is a matter of debate, a speaker here said.

“There are pros and cons to each of these approaches, but if you do scleral buckle very well, you get very good results,” Carl D. Regillo, MD, FACS, said at Retina 2019.

Recent large database studies indicate that primary RD single-surgery success rates, either scleral buckle or PPV, is about 85%.

“If you’re in that mid-80% or greater, you’re probably on par with community standards,” he said.

Personally, Regillo first determines whether the primary retinal detachment is amenable to pneumatic retinopexy. In cases of primary retinal detachment without flap tear, Regillo said he prefers scleral buckle alone. But, if there is associated flap tear, he performs PPV alone.

In that case, in both phakic and pseudophakic eyes, he performs complete vitrectomy with scleral depression, marks all breaks, enlarges the primary break anteriorly to relieve traction and maximize drainage, then lasers all breaks and suspicious areas.

Again, in his personal experience of 150 consecutive cases of primary RD managed with PPV alone, single operation success rate was 139 of 150 (93%).

“My approach has evolved over the years, but I utilize everything at my disposal to pick what is best for the individual patient,” he said. – by Patricia Nale, ELS

 

Reference: Regillo CD. The role of scleral buckling: Evidence and personal experience. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.

Disclosures: Regillo reports he receives research support from Genentech, Regeneron, Novartis, Alcon, NIH, Allergan, Astellis, Notal and Iconic, and he is a consultant for Genentech, Bayer, Novartis, Alcon, Allergan, Notal, Iconic, Shire and Kodiak.

 

Carl D. Regillo

WAIKOLOA, Hawaii — Whether to perform scleral buckle alone or add it to pars plana vitrectomy in cases of primary rhegmatogenous retinal detachment is a matter of debate, a speaker here said.

“There are pros and cons to each of these approaches, but if you do scleral buckle very well, you get very good results,” Carl D. Regillo, MD, FACS, said at Retina 2019.

Recent large database studies indicate that primary RD single-surgery success rates, either scleral buckle or PPV, is about 85%.

“If you’re in that mid-80% or greater, you’re probably on par with community standards,” he said.

Personally, Regillo first determines whether the primary retinal detachment is amenable to pneumatic retinopexy. In cases of primary retinal detachment without flap tear, Regillo said he prefers scleral buckle alone. But, if there is associated flap tear, he performs PPV alone.

In that case, in both phakic and pseudophakic eyes, he performs complete vitrectomy with scleral depression, marks all breaks, enlarges the primary break anteriorly to relieve traction and maximize drainage, then lasers all breaks and suspicious areas.

Again, in his personal experience of 150 consecutive cases of primary RD managed with PPV alone, single operation success rate was 139 of 150 (93%).

“My approach has evolved over the years, but I utilize everything at my disposal to pick what is best for the individual patient,” he said. – by Patricia Nale, ELS

 

Reference: Regillo CD. The role of scleral buckling: Evidence and personal experience. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.

Disclosures: Regillo reports he receives research support from Genentech, Regeneron, Novartis, Alcon, NIH, Allergan, Astellis, Notal and Iconic, and he is a consultant for Genentech, Bayer, Novartis, Alcon, Allergan, Notal, Iconic, Shire and Kodiak.

 

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