Comparison of Pars Plana Vitrectomy Alone Vs Pars Plana Vitrectomy Plus Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Breaks

Abstract

Rhegmatogenous retinal detachment with inferior retinal breaks remains a challenging surgical entity because conventional intraocular tamponade provides relatively less support to the inferior retina. Pars plana vitrectomy is widely used for primary repair; however, the additional benefit of segmental scleral buckle in inferior break-associated detachments remains debated. Objective: To compare the anatomical success, visual outcomes, and postoperative complications of pars plana vitrectomy alone versus pars plana vitrectomy combined with segmental scleral buckle in patients with rhegmatogenous retinal detachment involving inferior retinal breaks. Methods: This prospective randomized controlled trial was conducted at Eye Unit-III, Lahore General Hospital, Lahore, from August 2024 to January 2025. A total of 50 eyes of 50 patients with primary rhegmatogenous retinal detachment and inferior retinal breaks located between the 4 and 8 o’clock meridians were included. Patients were randomized into two equal groups. Group A underwent pars plana vitrectomy alone, while Group B underwent pars plana vitrectomy combined with segmental scleral buckle. The primary outcome was single-operation success rate at six months. Secondary outcomes included final anatomical success rate, postoperative best-corrected visual acuity, need for secondary intervention, and procedure-related complications. Results: Each group included 25 eyes. Baseline characteristics, including age, gender distribution, and preoperative best-corrected visual acuity, were comparable between the two groups. Single-operation success was achieved in 21 eyes (84.0%) in the pars plana vitrectomy alone group and 22 eyes (88.0%) in the combined surgery group. Final anatomical success was achieved in 23 eyes (92.0%) and 24 eyes (96.0%), respectively. Mean six-month postoperative LogMAR best-corrected visual acuity was 0.28±0.15 in the pars plana vitrectomy alone group and 0.25±0.13 in the combined surgery group, with no statistically significant difference. Localized myopic shift was more frequent in the combined surgery group, occurring in 6 eyes (24.0%) compared with 2 eyes (8.0%) in the pars plana vitrectomy alone group. No severe complications, including globe perforation, anterior segment ischemia, or proliferative vitreoretinopathy grade C or worse, were observed. Conclusion: Pars plana vitrectomy alone and pars plana vitrectomy combined with segmental scleral buckle both achieved favorable anatomical and visual outcomes in rhegmatogenous retinal detachment with inferior breaks. Although the combined approach showed a small numerical advantage in anatomical success, this benefit was limited and accompanied by a higher frequency of postoperative myopic shift. Pars plana vitrectomy alone appears to be an effective primary surgical approach in appropriately selected patients, while segmental scleral buckle may be reserved for selected high-risk cases requiring additional inferior retinal support.