Supplementary Material for: Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7212 Eyes

Purpose: The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB+PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear. Methods: A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB+PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated. Results: Across 18 studies, 3912 SB and 3300 SB+PPV eyes were included. Final BCVA was non-significantly different between SB and SB+PPV (20/38 vs. 20/66 Snellen; WMD=–0.11 LogMAR; 95%CI [–0.29,0.07]; P=0.23). Primary reattachment rate was similar between procedures (P=0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR=1.03; 95%CI [1.00,1.06]; P=0.04). Compared to SB+PPV, SB alone had a significantly lower risk of postoperative macular edema (RR=0.69; 95%CI [0.47,1.00]; P=0.05) and cataract formation (RR=0.34; 95%CI [0.12,0.96]; P=0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB+PPV. Conclusions: There was no significant difference in final BCVA between SB+PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.

研究背景：巩膜扣带术（scleral buckling, SB）与巩膜扣带术联合经睫状体平坦部玻璃体切除术（pars plana vitrectomy, PPV）用于孔源性视网膜脱离（rhegmatogenous retinal detachment, RRD）修复的疗效及安全性尚未明确。
方法：本研究开展系统评价与荟萃分析，检索2000年1月至2021年6月发表的、对比SB与SB+PPV治疗RRD的疗效和/或安全性的对照研究。以最终最佳矫正视力（best-corrected visual acuity, BCVA）为主要终点指标，视网膜复位率与眼部不良事件为次要终点指标。采用随机效应模型开展荟萃分析，计算95%置信区间（confidence interval, CI）。
结果：最终纳入18项研究，共包含3912例接受SB治疗的患眼与3300例接受SB+PPV治疗的患眼。两组患者的最终最佳矫正视力无显著差异（斯内伦视力表20/38 vs. 20/66；加权均数差WMD=-0.11对数最小分辨角LogMAR；95%CI [-0.29, 0.07]；P=0.23）。两种术式的初次视网膜复位率无显著差异（P=0.74）；但单纯SB术的最终视网膜复位率显著更高（97.40% vs. 93.86%；相对风险RR=1.03；95%CI [1.00, 1.06]；P=0.04）。与SB+PPV相比，单纯SB术后黄斑水肿（RR=0.69；95%CI [0.47, 1.00]；P=0.05）与白内障形成（RR=0.34；95%CI [0.12, 0.96]；P=0.04）的风险显著更低。两组在黄斑裂孔、视网膜前膜、视网膜下残留积液、增生性玻璃体视网膜病变、眼压升高及眼外肌功能障碍的发生率方面均无显著差异。
结论：孔源性视网膜脱离患者接受SB+PPV与单纯SB治疗的最终最佳矫正视力无显著差异。单纯SB术的最终视网膜复位率略高，且术后黄斑水肿与白内障形成的风险更低。两种术式的初次视网膜复位率及其他并发症的发生率均无显著差异。