Systematic Review Of Comparing Vitrectomy With Scleral Buckling For Uncomplicated Rhegmatogenous Retinal Detachment

Object: To evaluate the effects of vitrectomy surgery versus scleral buckling (SB) surgery for uncomplicated rhegmatogenous retinal detachment.Methods: Randomized controlled trials (RCTs) comparing vitrectomy with SB for uncomplicated RRD were searched in CCTR, Pubmed, Embase, CNKI and CBM -disc. Moreover, The Science Citation Index (SCI) and hand searching were also conducted. A meta-analysis were performed to compare best corrected visual acuity (BVCA) change, anatomic success and complications between the two operations. Results: Six RCTs with a total of 1213 participants were included. Three trials pointed at pseudophakiac or aphakic participants while two trials at phakic ones. The other one trial included both participants. Primary outcome was BCVA change, and in the meta analysis, the mean difference was 0.14 (95% CI: 0.01-0.27) in phakic group and 0.07 (95% CI: 0.01-0.13) in pseudophakic / aphakic group, which showed vitrectomy got better visual acuity than SB. Secondary outcomes was primary and final reattachment. In the meta analysis, the risk ratio of primary reattachment was 1.0 (95% CI: 0.9-1.11) in phakic group and 1.12 (95% CI: 0.97-1.3) in pseudophakic / aphakic group; while the risk difference of final reattachment was -0.00 (95% CI: -0.03 to 0.03) in phakic group and 0.03 (95% CI: -0.00 to 0.06) in pseudophakic / aphakic group. There was no significant difference between vitrectomy and SB in both primany and final reattachment.Conclusions: The BCVA change was much greater in vitrectomy procedure in both phakic and pseudophakic / aphakic eyes. While the anotomic success was similar in vitrectomy and SB. Comparing with SB, vitrectomy was superior in postoperative PVR, choroidal detachment, reoperations, refractive error, axial length change and operating time, but opposite in iatrogenic breaks and cataract progression.