Selection of scleral buckling for primary retinal detachment

PURPOSE: Rhegmatogenous retinal detachment (RRD) may be caused by a flap tear or by an atrophic hole along the lattice degeneration. The aim of this study was to see whether different types of scleral buckling could achieve comparable reattachment rates in eyes with specific types of RRD. PATIENTS AND METHODS: 128 eyes with RRD were assigned to receive 1 of 3 buckling procedures according to the following guidelines: retinal detachments caused by flap tears were treated with radial segmental buckling; retinal detachments caused by atrophic holes with limited lattice degeneration were treated with circumferential segmental buckling, and retinal detachments caused by multiple breaks with extensive lattice degeneration were treated with encircling buckling. RESULTS: 56 eyes received radial segmental buckling, 36 eyes received circumferential segmental buckling, and 36 eyes received encircling buckling. The reattachment rates in these three groups were 83.9, 86.1, and 88.9%, respectively (no statistically significant difference). The visual outcomes were comparable in all groups. Younger age, an increased requirement for subretinal fluid drainage, longer operation time, and myopic shift were noted in the encircling group. CONCLUSIONS: Comparable reattachment rates could be achieved in all three groups according to our guidelines. Segmental buckling is appropriate for two thirds of RRD in this study and has fewer complications than encircling buckling. Every retinal detachment behaves differently and should be subjected to its optimal buckling procedure to achieve the best results and to avoid unnecessary operative complications.