Outcomes and complications of sponges versus tires for scleral buckling in primary rhegmatogenous retinal detachment: The Manchester Buckle Study

Journal article

Purpose: To compare preoperative characteristics and postoperative anatomical and functional outcomes of scleral buckle surgery using sponges versus tires, as well as explant‐related complications and the frequency of explant removal. Methods: This retrospective study included patients with primary rhegmatogenous retinal detachment (RRD) who underwent primary scleral buckling at the Manchester Royal Eye Hospital between 2008 and 2023. Preoperative data included age, macula status, type of RRD, ocular comorbidities and best‐corrected visual acuity (BCVA). Postoperative outcomes included single‐surgery anatomical success (SSAS), BCVA and explant‐related complications (extrusion, infection, high intraocular pressure and persistent diplopia). Results: Among 562 patients (mean age 36 ± 12 years), 183 received sponges and 379 received tires. Sponges were more commonly used in dialysis‐related RRD (54% vs. 10%; p < 0.01) and macula‐off eyes (52% vs. 36%; p < 0.01), and associated with worse preoperative BCVA (logMAR 0.84 ± 0.81 vs. 0.57 ± 0.72; p < 0.01). SSAS rates were similar between groups (86.0% vs. 83.4%; p = 0.44) and mean BCVA improvement (ΔBCVA) did not differ significantly (0.39 ± 0.57 vs. 0.29 ± 0.58 logMAR; p = 0.29). In multivariable analysis adjusting for relevant clinical covariates, explant type was not independently associated with postoperative BCVA (B = –0.10; p = 0.28) or SSAS (aOR = 0.79; p = 0.71). Buckle extrusion occurred more frequently in the sponge group (12.6% vs. 3.4%; p < 0.01), leading to higher explant removal rates (14.8% vs. 6.1%; p < 0.01). Conclusions: Sponges were preferentially used in dialysis‐related RRD cases and were associated with worse preoperative BCVA and a higher proportion of macula‐off RRDs. SSAS rates and ΔBCVA improvement were similar between groups. Sponges had significantly higher extrusion rates, resulting in more frequent explant removal.

Authors: Kiraly, P; Lippera, M; Ally, N; Agarwal, R; Moussa, G

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Acta Ophthalmologica
• Publication date: 2026-01-27
• Acceptance date: 2026-01-14
• DOI: 10.1111/aos.70082
• EISSN: 1755-3768
• ISSN: 1755375X, 1755-375X
• Language: English
• Keywords: scleral buckling; best‐corrected visual acuity; single‐surgery anatomical success; explant extrusion; silicone tire; silicone sponge; explant; rhegmatogenous retinal detachment