Primary scleral buckle for rhegmatogenous retinal detachment: long-term outcomes

The Manchester buckle study,¹ a single-center retrospective study conducted at the Manchester Royal Eye Hospital, Manchester, UK, evaluated the long-term anatomic and visual outcomes of primary scleral buckle (SB) surgery for patients with a rhegmatogenous retinal detachment (RRD). The study aim was the identification of predictors of surgical and functional success.

The study was conducted from January 2008 to December 2023 and retrospectively analyzed all primary SB procedures performed at the hospital. The investigators recorded the preoperative, intraoperative, and postoperative data from the patient electronic records. The primary endpoints, according to the authors, were the single-surgery anatomic success (SSAS) rate, final anatomic success, and the visual acuity.

What did the retrospective analysis reveal?

The study included 608 eyes, of which SSAS was achieved in 515 (85%) and 602 (99%) achieved a final anatomic success rate. The mean best-corrected visual acuity (BCVA) increased significantly from 0.62 to 0.32 logarithm of the minimum angle of resolution (p < .01)

Multivariate analysis indicated that the factors that were independent predictors of reduced SSAS were patient age over 40 years (odds ratio [OR], 0.55; p = .004), macula-off status (OR, 0.65; p = .034), and ocular trauma (OR, 0.40; p = .012), the authors reported.

Two factors independently predicted of worse postoperative BCVA, ie, macula-off detachment (β = +0.36; p < .001) and ocular trauma (β = +0.42; p < .001).

The most common complications associated with SB were postoperative ocular hypertension in 7.4%, subretinal hemorrhage in 4.6%, and inadvertent deep sutures in 3.9%.

The clinical takeaways were that primary SB surgery achieved high anatomic success rates, meaningful visual improvement, and an acceptable complication profile. Macula-off status and ocular trauma were the strongest adverse predictors of both anatomical and functional outcomes, underscoring the importance of timely intervention before macular involvement.

Reference

1. Lippera M, Kiraly P, Ally N, et al. The Manchester buckle study: 15-year outcomes and predictive factors for success in scleral buckling for primary rhegmatogenous retinal detachment. Br J Ophthalmol. 2026;:bjo-2025-328525. published online July 7.cdoi:10.1136/bjo-2025-328525