Scleral band and vitrectomy in PVR

Despite decreasing use of scleral buckling among retinal surgeons, combining it with vitrectomy is a very effective technique for the treatment of complex retinal detachment cases, Borja Corcóstegui MD, of the Instituto Microcirurgia Ocular, Barcelona, told delegates at the 15th EURETINA Congress in Nice, France.

Dr Corcóstegui was speaking during the instructional course in management of proliferative vitreoretinopathy (PVR).  “The use of scleral buckling has vastly decreased in favour of primary vitrectomy for retinal detachment cases,” he said.

“There are various reasons for this transition from scleral buckling to vitrectomy, including simplified preoperative examination of patients, industry promotion of microincision vitrectomy and often higher reimbursement rates for vitrectomy. However, vitrectomy has several distinct disadvantages, such as cataract formation, subretinal perfluorocarbon, macular retinal folds and possibly increased long-term risk of glaucoma,” he added.

Despite this, retinal fellows are currently not offered a great deal of training in scleral buckling techniques, as vitrectomy has so many other indications, such as macular surgery and removal of vitreous haemorrhage.

“Several studies have suggested very variable results for the success rates of vitrectomy-only procedures for retinal detachments, so there is clearly room for improvement,” he said.

Dr Corcóstegui described the advantages of combining the two techniques to improve outcomes and decrease the chances of recurrent detachment.

“We know that it is currently impossible to remove all the vitreous gel from the vitreous base, but the addition of a scleral buckle helps support the base, reducing traction and thus the incidence of redetachment,” he said.