Title : Pneumatic retinopexy (pnr) versus pars plana vitrectomy (ppv) combined with scleral bulking (sb) for rhegmatogenous retinal detachment: Systematic review and meta-analysis
Objective: To compare the outcomes of Pneumatic Retinopexy (PnR) versus Pars Plana Vitrectomy (PPV) with Scleral Bulking (SB) in the treatment of rhegmatogenous retinal detachment.
Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A search of electronic information was conducted to identify all comparative studies of PnR versus PPV with SB in the treatment of rhegmatogenous retinal detachment. Primary outcomes included rate of reattachment and rate of complications. Secondary outcome measures were visual acuity and change in refractive error. Fixed effect model was used for the analysis.
Results: Four studies were selected enrolling 483 cases. A statistically significant difference was seen in retinal reattachment rates between the two interventions as PPV with SB outperformed PnR (OR = 0.10, P < 0.00001). Complications of both techniques varied depend on the adverse event. PPV with SB patients experienced a higher cataract development (OR = 0.05, P = 0.0002), yet both techniques produced a similar amount of intraocular pressure changes, and PnR produced a greater number of new retinal tears and post-operative proliferative vitreoretinopathy. In terms of secondary outcomes, both interventions improved visual acuity; more profoundly in the PPV with SB group. Additionally, this group also saw a correction in their refractive error. Subgroup analysis showed no significant difference in the rates of reattachment of eyes operated on by PnR and PPV with SB as a primary procedure or secondary procedure after failed PnR (P = 0.60).
Conclusion: PPV with SB is a superior option to PnR in the treatment of rhegmatogenous retinal detachment due to its greater reattachment rate and improvement in vision. Nevertheless, it is important to be wary about the increased likelihood of certain complications.