Purpose: This meta-analysis aimed to investigate the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs).
Methods: A systematic literature search was performed on Ovid MEDLINE, EMBASE and Cochrane CENTRAL from inception to July 2019. Randomized controlled trials (RCTs) comparing RRD management options were included. Outcomes were reported via risk ratios (RR) for categorical variables and weighted mean differences (WMD) for continuous parameters with 95% confidence intervals (95%CI). Risk of bias assessment was conducted using the Cochrane criteria and a random-effects model was used for analysis. The visual recovery and incidence of complications were primary endpoints, while primary reattachment rate was a secondary outcome.
Results: Sixteen RCTs and 2613 eyes were included. For PPV versus SB, early postoperative visual acuity favoured SB (weighted mean less than 1 month postoperatively: ~20/1000 for PPV versus ~20/160 for SB, p=0.03), but differences between groups were non-significant at other timepoints (e.g. 12+ months: ~20/60 for PPV and ~20/70 for SB). There was no difference between PPV and SB for primary reattachment (RR=1.05, 95%CI=[0.98,1.14], p=0.16). PPV was associated with a lower rate of choroidal detachment (RR=0.19, 95%CI=[0.06,0.60], p=0.004, NNT=11), hypotony (RR=0.08, 95%CI=[0.01,0.61], p=0.01, NNT=4) and strabismus/diplopia (RR=0.17, 95%CI=[0.03,0.96], p=0.04, NNT=25) relative to SB, while SB was associated with a lower incidence of iatrogenic breaks (RR=12.02, 95%CI=[2.31,62.55], p=0.003). Combination management was non-significantly different relative to PPV or SB alone for final CDVA, complications and reattachment rate. One trial comparing PR and PPV showed superior visual recovery and final acuity, less vertical metamorphopsia and reduced morbidity following PR.
Conclusions: PPV is associated with a slower visual recovery and less morbidity but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision and were associated with comparable safety outcomes. Emerging data suggests that, in certain primary RRDs, PR should be a first-line intervention over PPV.