Clinical Outcomes of Scleral Buckling in Elderly Patients with Rhegmatogenous Retinal Detachment: A Retrospective Cohort Study

Purpose: To evaluate the outcomes of scleral buckling in elderly patients with rhegmatogenous retinal detachment (RRD) and identify independent predictors of postoperative visual outcomes. Methods: This retrospective study included 290 eyes from 278 patients who underwent scleral buckling between 2018 and 2024. Patients aged ≥60 years were defined as the elderly group; those ≤30 years served as controls. Clinical parameters and surgical outcomes were analyzed. Logistic regression was performed in the elderly group to identify predictors of final visual acuity. Results: In elderly patients, scleral buckling achieved a single-surgery anatomical success (SSAS) rate of 98.23%, with 92.03% showing stable or improved vision. Compared to younger patients, the elderly group had lower rates of postoperative intraocular pressure elevation (7.08% vs. 25.99%, P<0.001) and subretinal hemorrhage (2.65% vs. 9.60%, P=0.023), but a higher prevalence of posterior vitreous detachment (PVD; 71.7% vs. 17.5%, P<0.001), which was associated with break location and RRD quadrant (P<0.001). In the elderly group, multivariate analysis identified baseline visual acuity, macula-on status, and grade C proliferative vitreoretinopathy as independent predictors of visual outcomes (P<0.05). Conclusion: Scleral buckling remains a safe and effective option for selected elderly RRD patients. Proper case selection and timely surgery are essential for achieving favorable outcomes in the vitrectomy era.