Chandelier-assisted versus standard scleral buckling for rhegmatogenous retinal detachment repair. Systematic review and meta-analysis
Reviewed by Sofia Rokerya

Despite a significant global decline in standard scleral buckling (SSB) procedures for rhegmatogenous retinal detachment (RRD), it continues to hold its place as an essential treatment option, offering distinct advantages such as cost-effectiveness, preservation of the vitreous, improved final visual acuity in phakic eyes, and less cataract progression. Nevertheless, the challenges of SSB surgery, including extended operation duration, a longer learning curve, and a higher incidence of neck and back discomfort for the surgeon, have led some to label SSB as a somewhat neglected or less-preferred technique, particularly among younger surgeons. Innovative chandelier-assisted scleral buckling (CSB) surgery was introduced in 2012 by Aras, et al. It involves the insertion of a transscleral light source, facilitating wide-field visualisation through the operating microscope similar to the field achieved during PPV. CSB is believed to offer several advantages over SSB including improved surgical visibility. At every step of this procedure, visualisation is done through the microscope instead of indirect ophthalmoscopy. There is a reduced risk of musculoskeletal stress for surgeons, shorter operation duration, and simplified cryopexy procedures. This ongoing study aims to compare the anatomical and functional outcomes, duration of operation, and complication rates between SSB and CSB for phakic eyes with RRD. PubMed, Embase, and Cochrane Library databases were searched from inception to June 2024. Out of 451 articles originally selected, nine were included in the final analysis to date. The primary endpoint was set as final success. The secondary endpoint was set as primary success, operation time, and final best corrected visual acuity (BCVA). The meta-analysis thus far shows that there is no statistical difference between CSB and SSB for the final success rate (RR=1.00, 95% CI=0.97–1.03). For the primary success rate, there was no statistical difference between CSB and SSB (RR=1.00, 95% CI=0.94–1.06). For operation time, the meta-analysis has shown that the CSB group is less than the SSB group (pooled MD=-15.8, 95% CI=-22.60 to -9.00). For postoperative complications, the study showed that the CSB group presented with lower pooled risk than the SSB group (RR=0.59, 95% CI=0.41–0.89). The trend for ERM formation risk was higher in the CSB group if there is no routine suture for the sclerotomy (p=0.08). In conclusion, CSB showcases a significantly reduced operation duration and less postoperative complications in contrast to the SSB group, maintaining comparable primary and ultimate anatomical success rates as well as final BCVA. Limitations: Small number of articles meeting inclusion criteria. Variable study designs of different studies. Majority of studies retrospective, only one being prospective. A primary performance bias observed where extra attention and caution are often applied to a newer surgical procedure. Publication bias that may tend to favour the reporting of false-positive results, leading to an overrepresentation of positive outcomes.

Comparison of chandelier-assisted versus standard scleral buckling for the treatment of primary rhegmatogenous retinal detachment: a systematic review and meta-analysis.
Kao YS, Chen CY, Huang YT, Chen SN.
OPHTHALMOLOGICA
2024 [ePub ahead of print].