International consensuses and guidelines on rhegmatogenous retinal detachment (RRD) surgery by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI)

Comprehensive Summary

Ruamviboonsuk et. al. established expert consensus on optimal rhegmatogenous retinal detachment (RRD) surgery practices with a Delphi consensus method. Fifteen experts were appointed to conduct an extensive and critical literature review of RRD and related surgical procedures. Controversy and consensus points were compiled into a series of statements that were reviewed by a group of 28 panelists, who anonymously voted using a Likert scale and gave feedback back to the group of experts. The experts reviewed the feedback before releasing a revised draft of their statements, which would be followed by another round of voting and feedback from the panelists. This process was repeated for each statement until a defined consensus of 75% agreement was reached. Ruamviboonsuk et. al. found that the experts agreed on most statements regarding surgical management of RRD, confirming the existing consensus that surgical choices should vary based on patient age, lens condition, and the characteristics of the retinal tear. Notably, scleral buckle (SB) was preferred in younger patients with phakic eyes, while pars plana vitrectomy (PPV) was preferred in complex detachment cases and pseudophakic eyes. Three topics that failed to reach consensus were whether SB or PPV should be used based on lens condition, the use of silicone oil as the default tamponade after complex RRD, and the use of 27-gauge needles in pediatric cases. The main limitation of this study was the possibility of selection bias, which is a typical drawback of Delphi-based studies.

Outcomes and Implications

With the complexity, prevalence, and recent developments in RRD surgery, this consensus study serves as a synthesized resource of current expert opinions on diagnosing and managing RRD. The identified topics that failed to reach a consensus serve as points of further discussion and research to improve RRD surgery and associated guidelines.