Clinical Report: Scleral Buckling for Phakic Rhegmatogenous Retinal Detachment

Overview

Scleral buckling (SB) demonstrates superior visual outcomes and lower cataract progression compared to pars plana vitrectomy (PPV) in phakic patients with rhegmatogenous retinal detachment (RRD). Despite its advantages, the use of SB has declined, raising concerns about the availability of expertise in this technique.

Background

Rhegmatogenous retinal detachment is a critical condition that can lead to significant vision loss if not treated promptly. While PPV has become the preferred surgical method, recent studies indicate that SB may offer better outcomes for phakic patients. Understanding the evolving role of SB is essential for optimizing patient care and preserving surgical options.

Data Highlights

Key Findings

• Scleral buckling offers superior visual outcomes compared to PPV in phakic eyes.
• SB has lower rates of postoperative cataract progression compared to PPV.
• Single-surgery success rates for SB can reach up to 93% with minimal complications.
• Meta-analyses confirm SB's advantages in visual rehabilitation and reduced retinal displacement.
• Modern SB techniques have improved safety and precision, particularly with nondrainage methods.

Clinical Implications

Retinal surgeons should consider scleral buckling as a viable option for phakic patients with RRD, given its superior outcomes. Training in SB techniques is essential to ensure that this option remains available for future patients.

Conclusion

Scleral buckling remains a critical technique in the management of phakic RRD, offering distinct advantages over PPV. Continued emphasis on SB training and practice is necessary to maintain high standards of patient care.

References

1. Mammo DA, Rachitskaya AV, Retinal Physician, 2022 -- Addressing Scleral Buckle Pitfalls
2. Jhaveri C, New Retinal Physician, 2020 -- Introduction to Segmental Buckling
3. Schwartz SG, Mieler WF, Retinal Physician, 2010 -- Surgery for Primary Rhegmatogenous Retinal Detachment
4. AAO, Guideline Central, 2025 -- AAO Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Guideline Summary
5. SPR Trial, PubMed -- Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment
6. Retinal Physician — Macular Buckling Technique in High Myopia
7. AAO Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Guideline Summary - Guideline Central
8. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study - PubMed
9. Scleral buckling as a standalone surgery in the era of pars plana vitrectomy: a 10-year retrospective cohort study | International Journal of Retina and Vitreous | Springer Nature Link