Scleral Buckling and Cryotherapy for Primary Retinal Detachment

Risk Factors and Technical Considerations

• Inadequate treatment of horseshoe tears, particularly at the anterior border where visualization is difficult, is a significant risk factor for failure 1, 2, 3
• Insufficient anterior extension of treatment, which must extend to the ora serrata if tears cannot be completely surrounded, can lead to failure 1, 2, 3
• The American Academy of Ophthalmology guidelines note that there is low to very low certainty evidence indicating little or no difference between pars plana vitrectomy and scleral buckling in anatomical and visual acuity outcomes, suggesting that scleral buckling with cryotherapy remains a comparable surgical approach 4, 5
• The chorioretinal adhesion from cryotherapy or laser is not firm or complete for up to 1 month following treatment, during which time continued vitreous traction can pull tears beyond the treated area 2
• New break development occurs in 10-16% of patients during long-term follow-up, with pseudophakic patients at higher risk 2