We read with interest the systematic review and meta-analysis by Chen et al. [1] showing that similar outcomes were noted postoperatively no matter whether retinopexy was performed in combination with scleral buckling or not. The authors observed similar reattachment rate, final VA and complication rates between the two groups.
The authors agree with the hypothesis that buckle placement is a permanent procedure and therefore its effect on retinal re-attachment is a permanent one. However, both clinical practice and literature have highlighted the fact that buckle removal may be required on several occasions for different indications [2,3,4]. Some common risk factors include exposed scleral buckle and infection, diplopia, patient discomfort or other ocular procedures [2,3,4]. While buckle removal may be a safe procedure if adequate retinopexy has been performed before, it is likely that buckle removal in non-retinopexy cases will result in retinal break re-opening and retinal re-detachment.