Visual Recovery after Scleral Buckling Procedure for Retinal Detachment

Purpose: To evaluate prognostic factors for visual and anatomic outcomes, including complications after scleral buckling procedure (SBP) for primary rhegmatogenous retinal detachments. Design: Retrospective, consecutive, nonrandomized, comparative interventional case series. Participants: Patients undergoing SBP for primary rhegmatogenous retinal detachment performed by a single surgeon. Methods: The patients' medical records were reviewed. Preoperative and intraoperative factors analyzed for their association with visual acuity and anatomic outcomes included macular detachment, duration of macular detachment, preoperative visual acuity, lens status, refractive error, extent of detachment, number of breaks, internal gas tamponade, and drainage of the subretinal fluid. Secondary outcomes included frequency of further surgery, complications, and fellow eye retinal detachment. The fellow eye of the patients was excluded from consideration of prognostic factors. Main Outcome Measures: Best-corrected visual acuity at 2 months and at final follow-up examination as well as anatomic factors including retinal reattachment at 1 day, 2 months, and last follow-up examination. Results: There were 672 patients studied, including 457 (68%) with macular detachment. The use of gas, drainage of subretinal fluid, and lens status did not influence final anatomic or visual results. Macular detachment was the most important prognostic factor for anatomic (P = 0.031) and visual acuity success (P<0.001). Better preoperative visual acuity (P<0.001), fewer quadrants involved by the detachment (P<0.001), and lack of high myopia (P = 0.001) were important positive prognostic factors for visual acuity. The duration of macular detachment was not of prognostic value up to 30 days' duration. Conclusions: Visual recovery after retinal reattachment was most dependent on macular involvement. Duration of macular detachment had surprisingly little influence on postoperative visual acuity.