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Primary rhegmatogenous retinal detachment repair: evidence supports an individualised approach
  1. Charles C Wykoff1,
  2. Stephen G Schwartz2,
  3. Ron A Adelman3,
  4. Alexander J Brucker4,
  5. Harry W Flynn Jr2
  1. 1Retina Consultants of Houston, Blanton Eye Institute and Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA
  2. 2Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  3. 3Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4The Scheie Eye Institute, University of Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Charles C Wykoff, Retina Consultants of Houston, Blanton Eye Institute and Houston Methodist Hospital, Weill Cornell Medical College, 6560 Fannin Street, Suite 750, Houston, TX 77030, USA; ccwmd{at}houstonretina.com

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Rhegmatogenous retinal detachment (RRD) is a common clinical challenge that affects up to one of every 170 people.1 RRD treatment is one of the most common indications for vitreoretinal surgery, and such repair is one of the most cost-effective practices in the treatment of all vitreoretinal disorders.2–4

Retinal reattachment surgery is unusual among ophthalmic surgeries because excellent outcomes may be obtained using three distinct approaches: scleral buckling (SB) first described in the 1950s,5–7 pars plana vitrectomy (PPV) first reported in 19718 and pneumatic retinopexy (PR) first reported in 1986.9 Core surgical principles for RRD management include identification and treatment of all retinal breaks.10

PPV is increasingly employed in the repair of primary RRD. A 2012 US Medicare claims database analysis reported 74%, 11% and 15% of primary RRD being repaired with PPV, SB and PR, respectively,11 with substantial regional differences. Given the expansion of PPV use, vitreoretinal fellows are being exposed to fewer SB procedures. In a 2010 survey of 66% of USA vitreoretinal fellows, it was reported that 39% performed <20 SB and 22% performed and assisted in <40 primary SB.12 Despite this evolving trend in surgical exposure during training, many surgeons still use SB. The 2015 Preferences and Trends survey revealed 67% of surgeons place an SB in 11% or more of RRD surgeries, with 24% placing an SB in 41% or more of RRD surgeries.13

While high surgical success rates can be achieved with each technique, all approaches to primary RRD repair have less than perfect success rates: 10–40% of eyes require more than one surgical procedure, and as many as 5% of eyes may sustain permanent anatomic and functional failure despite favourable surgical timing …

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