Comparison between scleral buckling and vitrectomy in the onset of cystoid macular edema and epiretinal membrane after rhegmatogenous retinal detachment repair

Purpose: To investigate the incidence and risk factors for the main complications in patients with rhegmatogenous retinal detachment (RRD) treated with scleral buckling (SB) or pars plana vitrectomy (PPV). Methods: A retrospective, comparative, observational study was conducted. The medical records of 107 patients with primary RRD, who were managed with SB (n= 57) or PPV (n=50) were reviewed. SB was performed using scleral encircling solid silicone band and circumferential solid silicone exoplant to support the break. PPV was combined with phacoemulsification in phakic eyes and with scleral encircling in inferior detachments.Follow-ups, including SD-OCT examination, were scheduled at 1, 3 and 12 months after surgery. Propensity score matching was used to adjust for potential preoperative selection bias. Results: The overall incidence of postoperative cystoid macular edema (CME) and epiretinal membrane (ERM) was 14.95% and 30.84%, respectively. Compared to SB, CME was more frequent in the PPV (p=0.021) as well as in the PPV pseudophakic eyes (p=0.027). Postoperative CME was an early, predominantly transient complication and regressed in 67% of SB and in 77% of PPV eyes within 12 months after surgery. No differences were observed regarding ERM development. Except for the surgical technique, no preoperative factors associated with CME were identified. A correlation between ERM and patients' age was found (p=0.028). Conclusions: The incidence of CME after RRD repair was higher in patients who underwent PPV, either alone or combined with phacoemulsification, than in those treated with SB. ERM development was correlated to older age, regardless of the surgical procedure.