Alireza Ramezani, Morteza Enrezari, Parisa Ashtar-Nakhaie, Arman Moolazade, Mehdi Yaseri (Tehran, Iran)

Advantages:

Compared to the classic method of scleral buckling surgery with retinopexy (using intraoperative cryotherapy, indirect laser or diathermy, and postoperative laser photocoagulation), the method without retinopexy provides faster and easier surgery, less chance of intraoperative complications, and no expense or trouble from postoperative laser. In addition, in the non-retinopexy method breakdown of blood-ocular barrier is less frequent and less severe which may result in lower rates of postoperative cystoid macular edema, macular pucker, and PVR progression.

Methods:

In this method, breaks are localized and closed with an appropriate radial or circumferential sponge and/or circumferential silicone buckle with band. Subretinal fluid drainage is done if needed. No form of retinopexy creating a chorioretinal adhesion is performed. Either during or following the surgery.

Effectiveness / Safety:

In a retrospective, nonrandomized, interventional, comparative case series, the data of 71 phakic eyes of 71 patients with rhegmatogenous RD that underwent scleral buckling surgery were evaluated. The surgeries in 41 consecutive eyes were accompanied by retinopexy performing either intraoperative transscleral cryotherapy (6 cases) or postoperative laser photocoagulation (35 cases). The next 30 eyes did not receive retinopexy. The two groups were matched regarding age, sex, history of trauma or high myopia, and duration of RD before the surgery as well as the characteristics of the breaks and RD except for the RD extension, which was more in the non-retinopexy group. Retinal redetachment happened in 4 patients (13.3%) of the non-retinopexy group and in 6 patients (14.6%) of the retinopexy group. The difference was not statistically significant (P>0.999).

Take home message:

Retinopexy does not seem to have beneficial effect to in scleral buckling surgery for phakic rhegmatogenous RD neither in terms of anatomical nor functional success. However, this conclusion has to be confirmed in a randomized clinical trial.