Refractive Outcomes of Retinal Detachment Repair in Patients with Multifocal Intraocular Lenses with and without Scleral Buckling.
PURPOSE To compare the refractive, visual, and anatomic outcomes following rhegmatogenous retinal detachment (RRD) repair in pseudophakic patients with prior placement of multifocal intraocular lenses (MFIOLs) treated by combined pars plana vitrectomy and scleral buckling (PPV/SB) or PPV alone. DESIGN Retrospective clinical cohort study. METHODS A total of 100 patients with MFIOLs who underwent RRD repair at a single tertiary academic center between January 1, 2014 and November 1, 2025 were reviewed. Sixty-two eyes underwent PPV alone and 38 eyes underwent combined PPV/SB. Demographic characteristics, surgical details, pre- and post-operative refraction, best-corrected visual acuity (BCVA), and complications were collected. The primary outcome was change in spherical equivalent at least 3 months following RRD repair. Secondary outcomes included visual acuity and single-surgery anatomic reattachment. RESULTS Post-operative refractions were obtained at an average of 5.4±3.3 months following RRD repair. Eyes treated with PPV alone demonstrated a mean postoperative myopic shift of -0.05±0.53D compared with -1.03±0.78D in eyes that received SB as part of repair (p<0.05). Twenty-three of thirty-three SB-treated eyes (60.5%) demonstrated a postoperative myopic shift of ≤ -1.0D and nine eyes (23.7%) demonstrated a shift of ≤ -0.5D. Patients receiving #240 bands demonstrated the smallest mean myopic shift (-0.78±0.62D) compared with #41 bands (-1.14±0.84D) and #42 bands (-2.0±0.71D), although differences were not statistically significant (p=0.07). Single-surgery anatomic reattachment was achieved in 53 of 62 eyes (85.5%) treated with PPV alone and 34 of 38 eyes (89.5%) that received SB as part of the repair (p=0.56). No significant differences were noted in pre-operative or post-operative BCVA between treatment groups. CONCLUSIONS Compared with eyes treated with PPV alone, the addition of a SB was associated with approximately -1.0D greater postoperative myopic shift while demonstrating similar visual and anatomic outcomes. Refractive outcomes following SB placement in patients with MFIOLs were comparable to prior reports in pseudophakic populations and may not represent a clinically prohibitive refractive change. These findings suggest that the addition of an encircling SB remains a viable option for RRDs in refractive-optimized patients.