We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate.

In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.

我们回顾了关于睫状体玻璃体切除术 (PPV)、巩膜扣带术 (SB) 和气动视网膜固定术 (PR) 治疗孔源性视网膜脱离 (RRD) 的疗效和安全性的文献。从成立到 2020 年 9 月，对三个数据库进行了系统搜索。纳入了比较 RRD 管理方案的随机对照试验 (RCT)。使用随机效应模型进行荟萃分析。纳入了 18 项 RCT 和 2,751 只眼睛。对于 PPV 与 SB，术后早期矫正距离视力 (CDVA) 偏向于 SB（加权平均术后 <1 个月：PPV 的手指数与 SB 的约 20/260 相比，P = 0.02），但在其他时间点差异不显着. 初次再附着没有差异（P = 0.08）。PPV 的脉络膜脱离发生率较低（P = 0.004），低眼压 (P = 0.01) 和斜视/复视 (P = 0.04)，但相对于 SB，医源性中断 (P = 0.003) 和白内障发展/进展 (P = 0.05) 的发生率更高。对于 CDVA、并发症和再附着率，联合管理与单独 PPV 相比没有显着差异。

最后，PPV 与较慢的视力恢复相关，但与 SB 相关的最终视力和初次再附着率相似。与独立 PPV 相比，联合程序并未提高初次再附着率或视力。在纳入的试验中发现了异质性，需要进一步的随机试验来减少这些估计的不确定性。