Paediatric eyes repair better with scleral buckling, adults need vitrectomy only for giant retinal tear-related detachments

Video transcript

My name is Sally Ong. I'm an assistant professor of ophthalmology at the Wake Forest University School of Medicine as well as an adjunct professor of ophthalmology at Wilmer Eye Institute.

At the Wilmer Eye Institute, we completed a multicentre, retrospective cohort study looking at giant retinal tear related retinal detachments that were surgically repaired with vitrectomy versus vitrectomy and scleral buckling. And we examined surgical, anatomic and functional success between the two groups.

We found that there were really no differences in baseline demographics between the two groups, except for a higher preponderance of patients with developmental abnormalities in the vitrectomy and scleral buckling group versus the vitrectomy alone group.

We also found there were no differences in the use of surgical adjuncts between the two surgical groups. There were no differences in rates of retinectomy, drainage retinotomy, and no differences in the use of surgical tamponade between the two groups.

When we looked at anatomic success rates, we found that there was no difference in single surgery anatomic success at six months or one year between the two surgical groups. The single surgery anatomic success for vitrectomy-only eyes was 77% versus for vitrectomy and scleral buckling eyes, it was 86%.

Next, we stratified the eyes by age. And we found that in children less than 18 years of age, there was a difference in single surgery anatomic success at one year. Specifically, the success rate was higher in vitrectomy and scleral buckling group: it was 89% versus in the vitrectomy-only group, the success rate was 56%.

However, when you looked at adults, there was no difference in single-surgery anatomic success between the two surgical groups.

We also looked at visual functional outcomes. And in adults, again, there was no difference in visual outcomes at one year between the two surgical groups; however, in children, there was a difference in the two surgical groups. Visual outcomes were better in the vitrectomy and scleral buckling group, versus vitrectomy-only group for children.

So in conclusion, we found that in eyes with giant retinal tear-related retinal detachment, for adults at least, there was no difference in anatomic or visual, functional success at one year between vitrectomy alone versus vitrectomy and scleral buckling. However, in children, we found that anatomic and visual outcomes success was higher in the group that was treated with vitrectomy and scleral buckling versus vitrectomy alone.

And we hypothesize that is because when you have a giant retinal tear, it looks almost like a relaxed retina to me. And that may be sufficient for adults, but in children, where the vitreous is still very formed, having that scleral buckle as an adjunct, it's really helpful to increase your surgical anatomic and functional success.