Scleral Buckling in Primary Vitrectomy for Giant Retinal Tears: A Systematic Review and Meta-Analysis of Anatomical and Functional Outcomes.

Abstract

Topic: Giant retinal tear-associated retinal detachments (GRT-RD) pose unique surgical challenges with high rates of recurrence and poor visual outcomes.

Clinical relevance: Pars plana vitrectomy (PPV) is the gold-standard treatment, but the role of adjunctive scleral buckling (SB) remains controversial. This meta-analysis compares anatomic and functional outcomes between PPV + SB vs PPV alone.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature search after librarian review was performed on four databases (PubMed, Embase, CENTRAL, and Web of Science) on November 6^th, 2025. Studies with at least 10 patients per arm that compared single-surgery anatomic success (SSAS), final anatomic success (FAS), and final visual acuity (VA) of 20/200 Snellen or better were included. Risk of bias was assessed using the ROBINS-I tool. Quality of evidence was assessed using the GRADE framework.

Results: The search yielded 1,306 unique abstracts, of which 177 underwent full-text review, and 11 were selected for meta-analyses. Across 10 studies, the SSAS did not differ between PPV + SB and PPV alone (RR = 1.07, p = 0.26). Post-hoc subgroup analysis showed no difference in studies with a mean age ≥ 40 years (RR = 0.97, p = 0.50), but significantly higher SSAS odds with PPV + SB in studies with mean age < 40 years (RR = 1.53, p = 0.002) and a significant interaction between subgroups (p = 0.002). Four studies evaluating FAS found no significant difference between groups (RR = 1.04, p = 0.14). Similarly, three studies comparing final VA ≥ 20/200 revealed no significant difference (RR = 1.07, p = 0.53). Across four studies, PPV + SB cases involved a significantly higher proportion of phakic eyes preoperatively (RR 1.36, p < 0.01). Additionally, two studies reported higher PVR rates and two reported more frequent inferior GRTs in the PPV + SB group. Due to imbalances in baseline characteristics that may affect the outcome, studies were graded as moderate to serious risk of confounding. Nine studies were at "Serious" risk of bias; two studies were evaluated as "Moderate" risk (ROBINS-I). The predefined outcomes of SSAS, FAS, and final VA were assessed as comprising very low quality of evidence (GRADE).

Conclusions: PPV + SB may be associated with higher SSAS in younger patients with GRT-RDs, while final anatomic and visual outcomes may be comparable to PPV alone. Surgeons appear to use adjunctive SB in eyes with preoperative features that suggest higher risk of recurrent detachment. Prospective, randomized studies are needed to determine whether adjunctive SB confers a true therapeutic benefit.