SPR study shows value of scleral buckling surgery

Retinal surgeons need to retain skill in performing scleral buckling because that procedure has a benefit compared with primary vitrectomy for the management of complex retinal detachment in phakic patients, said Michael H. Foerster, MD, at the World Ophthalmology Congress.

Dr. Foerster's comments were based on the results of the German, prospective, multicenter Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachments (SPR) study. He noted that analyses of data collected in a retinal detachment recruitment study showed there were some ophthalmology departments in Germany where scleral buckling surgery was no longer being performed.

"There has been concern that scleral buckling will become a lost art within a very short time," said Dr. Foerster, professor and chairman, Eye Clinic of the Charité Universitats Medizin, Berlin, Germany. "However, findings from the SPR study show the importance of being able to perform this technique because it is so much better for phakic patients."

The SPR enrolled 681 patients at 23 centers and included 46 surgeons who were required to have experience performing at least 100 scleral buckling and 100 vitrectomy procedures. Patients were stratified by lens status, randomly assigned to surgery with scleral buckling or primary vitrectomy, and followed for 1 year.

Among the phakic patients, there was no significant difference between surgical groups in the primary endpoint analysis of change in best-corrected visual acuity or with respect to re-detachment rates. However, there was a significant advantage of scleral buckling for reducing the rate of cataract development and need for cataract surgery. Based on that finding, scleral buckling surgery was recommended as the first surgical intervention for phakic patients with complex rhegmatogenous retinal detachment.