Effect of adjunctive scleral buckling on the outcomes of pars plana vitrectomy in retinal detachment repair

Background: Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition requiring prompt surgical repair. Pars plana vitrectomy (PPV) and scleral buckling (SB) are standard surgical interventions for RRD, but the added value of combining these treatments is debated. While PPV offers enhanced visualization and safety in complex RRD cases, SB may provide additional support in selected scenarios. However, the impact on functional outcomes, particularly contrast sensitivity (CS), remains unclear. In this study, we compared the anatomical success and visual function, including best-corrected distance visual acuity (BCDVA) and CS, between patients with primary RRD who were treated with PPV alone and those who were treated with combined PPV+SB. Methods: This comparative cross-sectional study included consecutive patients with primary RRD who were treated at Madinah Teaching Hospital, Faisalabad, Pakistan, from October 2020 to July 2021. Participants underwent either 25-gauge PPV or 25-gauge PPV combined with SB, based on their clinical indications. BCDVA and CS were measured monocularly under standardized photopic conditions using the logarithm of the minimum angle of resolution (logMAR) visual acuity chart and the Pelli–Robson chart, respectively. Anatomical reattachment status was assessed by dilated fundus examination. Postoperative evaluations of BCDVA, CS, and anatomical reattachment rate were conducted at 1 day, 1 month, and 3 months after treatment. Results: Ninety eyes of 90 patients with primary RRD were included (PPV: n =  45 eyes; PPV+SB: n = 45 eyes). The PPV group was approximately a decade younger (45.2 vs. 55.4 years, P < 0.05), while sex distribution was similar in both groups (P > 0.05). Anatomical success rates improved over 3 months, reaching 74.0% (n = 33) for PPV versus 62.2% (n = 28) for PPV+SB. PPV achieved significantly better final BCDVA (2.71 vs. 2.84 logMAR, P < 0.05). CS increased significantly over time in the PPV group (P < 0.05) but remained stable in the PPV+SB group (P > 0.05). Although the final CS was significantly higher in the PPV+SB group compared to the PPV group (P < 0.05), this difference reflected the higher baseline values in the former group. Overall, PPV alone provided greater anatomical and functional improvement over 3 months than did the combined surgery. Conclusions: Standalone PPV achieved higher anatomical success rates and greater visual acuity improvement over 3 months than did combined PPV+SB, while CS gains favored PPV+SB, but largely reflected higher baseline values. Despite mixed evidence in the literature, our findings suggested that PPV alone may suffice for treating selected uncomplicated RRD cases. Further large, randomized studies are needed to clarify the optimal surgical approach across different patient and RRD profiles.