Buckling Surgery For Retinal Detachment Research Articles

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

Cataract Outcomes Following Scleral Buckle Surgery for Retinal Detachment.

To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD). A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted. Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes. Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

Autofluorescence Imaging in the Long-Term Follow-Up of Scleral Buckling Surgery for Retinal Detachment.

Purpose To analyse fundus autofluorescence (AF) changes in retinal reattachment following primary scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD). Methods Prospective noninterventional chart review study. AF images were reviewed for peripheral and central changes and compared to clinical and OCT findings. Results A total of 73 eyes from 69 patients were included, four presenting with bilateral RRD. Mean age was 55 ± 12 years, male/female ratio 40/29, fovea-on/-off RRD 43/30, and mean follow-up time 376 ± 270 days, with a mean of 5 ± 3 postoperative visits. Preoperatively, RRD was seen as a hypofluorescent area with a hyperfluorescent leading edge. Immediately postoperatively, three types of cryopexy could be differentiated, gradually transforming to scleral hyperfluorescence. Buckle tightening produced alternating hyper-/hypofluorescent streaks, and demarcation lines showed a persistent rugged hyperfluorescent signal. Choroidal detachment led to transient hypofluorescence, whereas vortex vein compression induced persistent hypofluorescence. Peripheral retinal folds were hyperfluorescent and the drainage site was hypofluorescent. AF was highly sensitive in detecting even small amounts of hyperfluorescent persistent subretinal fluid (SRF) that showed a slow resolution during follow-up. A granular “salt-and-pepper-” like pattern in the central macula was seen in 80% of eyes with fovea-off RRD and alternating streaks in 10%. Findings from OCT imaging correlated well with AF regarding SRF, macular oedema, retinal pigment epithelial detachment, and presence of a subretinal scar, but only moderately in epiretinal membrane formation and choroidal folds. Conclusions AF is a useful, noninvasive, adjuvant tool in the long-term follow-up after SB surgery.

Incidence and Risk Factors for Intraocular Pressure Rise after the Scleral Buckle Surgery for Retinal Detachment.

Purpose:To determine the incidence and risk factors for intraocular pressure (IOP) rise after the scleral buckle (SB) procedure for retinal detachment (RD).Methods:A retrospective chart review of the medical records of patients, who underwent RD repair by SB performed by a single surgeon and had a minimum follow-up of 6 months was carried out. The outcome measures were the incidence of IOP rise in the operated eyes and the associated risk factors.Results:Fifty-two eyes of 52 patients with a median postsurgical follow-up of 18 months (interquartile range: 6, 36, range: 6–60 months) were included. Seven eyes had encircling buckle, 23 eyes had encircling buckle and 1 quadrant segmental buckle, and 22 eyes had encircling buckle and 2 quadrant segmental buckle. IOP rise was seen in 15/52 eyes (28.85%), within 1 month of the SB surgery. Nine out of 15 eyes (60%) of patients <40 years of age had a rise in IOP as compared to 6/37 eyes (16.2%) of patients >40 years of age (P = 0.002). Patients <40 years had a significant increased risk of developing IOP rise, compared to those above 40 years of age (adjusted odds ratio: 7.246 with 95% confidence interval of 1.641–31.986, P = 0.009). None of the fellow eyes had a rise in IOP during the follow-up period. None of the operated eyes with raised IOP progressed to glaucoma.Conclusions:Elevated IOP is a common complication after the SB procedure, and age <40 years is associated with a greater risk of development of increase in the IOP. Hence, IOP monitoring after the SB surgery is of paramount importance to detect early rise during follow-up.

Wide-angled endoillumination vs traditional scleral buckling surgery for retinal detachment - a comparative study.

PurposeTo evaluate the surgical outcomes of traditional scleral buckling (TSB) compared to chandelier-assisted scleral buckling (CSB) for rhegmatogenous retinal detachment repair.Patients and methodsA retrospective interventional comparative case series of 49 eyes that underwent SB procedure. Medical records of 27 and 22 eyes that underwent TSB and CSB surgery, respectively, were evaluated. Outcome measures included primary anatomical success, visual acuity (VA), and perioperative complications.ResultsPrimary reattachment rate was similar with 85.2% in the TCB group and 81.8% in the CSB group (P=1.00); eight patients needed one additional operation or gas injection with a final reattachment rate of 100% at 6 months. Mean VA in the CSB group improved from 20/60 at presentation to 20/35, 6 months postoperatively. In the TSB group, VA improved from 20/80 to 20/45 (P=0.90). Among the eyes that were successfully reattached with either SB approach, two eyes in each group had cataract progression and none of them required surgery during follow-up. No cases of endophthalmitis were observed.ConclusionCSB is a modified technique with an advantage of superior visualization compared with the traditional surgery, which simplifies the operation, enhance competency, and could be used as a valuable educational tool. It can provide similar anatomical and functional outcomes with no additional perioperative complications.

New Scleral Depressor Marker for Retinal Detachment Surgery

To report the efficacy of the use of a new scleral depressor marker during scleral buckling surgery for retinal detachment. Noncomparative, consecutive case series study. Eleven patients (11 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling surgery performed by 2 experienced vitreoretinal surgeons. The prototype of a new indenter marker was used during scleral buckling surgery. The possibility of performing simultaneous indentation and selected marking of the desired area was assessed. Additionally, the precision of the fiber light-assisted indentation as well as force of indentation were evaluated. The use of a new depressor marker facilitated a quick and effective flow of the standard surgery for retinal detachment. It was possible to perform indentation and marking as separate steps of 1 session. Only desired areas of the sclera were marked during the same indentation session. The indentation required less force. When combined with chandelier light, the precision of the marking was improved as demonstrated by a light from the chandelier indicating the highest point of the indentation area. There were no complications related to the use of the new instrument. The newly developed scleral depressor marker facilitated simultaneous indentation and marking on the sclera. The new instrument allowed for the selective marking of the desired areas during the same session of indentation. Additionally, it can be combined with chandelier fiber light, which improves the precision of the marking.

Ice compresses aid the reduction of swelling and pain after scleral buckling surgery.

To investigate the therapeutic effects of a local ice compress in alleviating eyelid swelling and errhysis and providing relief from pain after surgery. Eyelid swelling and pain are the most common postoperative symptoms after scleral buckling surgery. A local ice compress can reduce the severity of swelling, errhysis and pain after acute injury as well as after surgery. A retrospective study. A total of 100 patients who had undergone scleral buckling surgery for retinal detachment were classified into an ice compress group or a control group. All patients received standard postoperative medical care: a 1% Tropicamide ophthalmic solution (Minims® Tropicamide; Bausch & Lomb, Surrey, UK), a 1% prednisolone acetate (Pred-Forte; Allergan, Irvine, CA, USA), an ophthalmic tobramycin 0·3%/dexamethasone 0·1% combination ointment (Tobradex® ; Alcon, Fort Worth, Texas, USA) and 0·5% Levofloxacin eye drops (Santen Pharmaceutical, Osaka, Japan), plus a homemade ice pack was placed over the operated eye of patients in the ice compress group for 30minutes, three times a day for two consecutive postoperative days. The severity of swelling, pain and errhysis in the operated eyes was significantly lower in the ice compress group. The local ice compress therapy helped reduce swelling, errhysis and pain in the operated eye after scleral buckling surgery. Use of a local ice compress after scleral buckling surgery can reduce swelling and pain on operated eyes, providing greater comfort for patients.

Retinal Detachment Due to Retinal Dialysis: Surgical Outcome After Scleral Buckling.

The aim of this study was to determine the efficacy and safety of scleral buckling surgery in retinal detachment due to retinal dialysis. This study was a prospective, interventional case series. A total of 48 eyes of 48 consecutive patients were included after obtaining informed written consent. Besides taking a thorough history, all eyes were examined by a retinal surgeon. The macula status, site, and extent of retinal dialysis and rhegmatogenous retinal detachment (RRD) were particularly noted. Proliferative vitreoretinopathy grading was done. Buckling was performed by a single surgeon. At every follow-up, visual acuity, intraocular pressure, retina status, and buckle position were noted. Any complication found was recorded. Follow-up was done for at least 6 months. SPSS version 16 was used for data analysis. We included 48 cases of RRD due to retinal dialysis. The mean ± SD age of the patients was 26.85 ± 15.1 years. The macula was detached in 85.4% of the cases, and proliferative vitreoretinopathy grade C was found in 25% of the cases. A surgical reattachment rate of 95.8% was attained after a single primary buckling procedure. Final Snellen best-corrected visual acuity of 6/18 or better was attained in 12.5% of the cases. However, 62.5% of the cases had best-corrected visual acuity in the range of 6/24 to 6/60. Subretinal hemorrhage occurred in 8.3% of cases intraoperatively after subretinal fluid drainage. We conclude that scleral buckling has a definite role in the management of RRD due to retinal dialysis.

Evaluation of the Effect of Scleral Buckling on the Anterior Chamber Angle Using ASOCT

To evaluate the change in anterior chamber angle parameters after scleral buckling surgery using anterior segment optical coherence tomography (ASOCT). Fifty-five phakic eyes of 55 subjects undergoing scleral buckling with the placement of an encircling band for primary rhegmatogenous retinal detachment were included in this study. Anterior chamber angle assessment was performed using ASOCT. The trabecular iris angle (TIA), the angle-opening distance, and the trabecular iris space area were the parameters obtained preoperatively and 48 hours, 1 week, and 1 month after the surgery using ASOCT. The intraocular pressure (IOP) was measured using Goldmann applanation tonometry. The mean age of the patients was 43.2±11.3 years; there were 38 male and 17 female patients. There was a significant decrease in all the angle parameters (TIA, angle opening distance, and trabecular iris space area) at 48 hours, 1 week, and 1 month after surgery (P<0.0001). TIA 180 degree decreased from 41.93±14.27 degrees preoperatively to 31.09±10.52 degrees (P<0.0001) and TIA 0 degree from 42.7±14.04 degrees to 32.92±12.17 degrees (P<0.0001) at 48 hours postoperatively. The mean IOP at 48 hours (17.04±3.26 mm Hg) was significantly higher than the preoperative level (12.68±1.96 mm Hg; P<0.001). No significant difference was noted between the mean preoperative IOP and the IOP readings at 1 week (P=0.402) and 1 month (P=0.23) postoperatively. ASOCT imaging reveals that scleral buckling surgery for retinal detachment induces significant narrowing of the anterior chamber angle.

ULTRA-WIDEFIELD AUTOFLUORESCENCE IMAGING IN THE EVALUATION OF SCLERAL BUCKLING SURGERY FOR RETINAL DETACHMENT

To investigate the use of ultra-widefield fundus autofluorescence imaging in the early postoperative evaluation of scleral buckling surgery for retinal detachment. Forty-five eyes from 44 patients with rhegmatogenous retinal detachment were included. Ultra-widefield fundus autofluorescence imaging (Optomap P200Tx) was performed from both eyes preoperatively and early (1-2 days) postoperatively. All patients were operated with 2.5-mm encircling band, 6-mm to 9-mm segmental buckle, transscleral cryopexy, and the choice of drainage and air/gas endotamponade. The mean age of the patients was 58 ± 12 years, and the ratio of macula on-off detachments was 19/26. Light cryopexy induced hyperfluorescence of the treated area (in 11% of cases). Moderate cryopexy resulted in central hypofluorescence with a hyperfluorescent halo (in 51% of cases), whereas extensive cryopexy and disruption of the retinal pigment epithelium resulted in a broad hypofluorescent area (in 36% of cases). Tightening of the indenting elements induced peripheral hyperfluorescent radial streaks in 47% of cases and distinct areas of hyperfluorescence in 58% of cases. Demarcation lines and residual subretinal fluid were observed as hyperfluorescent areas. Central autofluorescence changes were observed in 96% of macula-off surgeries, whereas only 27% of these cases showed distinct hyper- and hypo-autofluorescent streaks. Ultra-widefield fundus autofluorescence imaging is a useful adjuvant tool for evaluating early outcome and retinal pigment epithelium function after scleral buckling surgery for retinal detachment.

Scleral buckle removal as treatment for persistent subfoveal fluid after scleral buckle surgery for retinal detachment.

To describe the removal of scleral buckle (SB) as a potential treatment option for persistent subfoveal fluid after SB retinal reattachment surgery. Case report of a single patient. A 56-year-old man with a preoperative best-corrected visual acuity of 20/20 underwent SB surgery for a macula-on retinal detachment. Postoperatively he developed subfoveal fluid with best-corrected visual acuity ranging from 20/30 to 20/40. Nine months after the original retinal reattachment surgery, the patient underwent SB removal as a treatment for persistent subfoveal fluid and incomplete recovery of visual acuity. One week after SB removal, the subfoveal fluid was substantially diminished and best-corrected visual acuity had returned to 20/20. This case suggests that removal of SB after retinal reattachment may be a viable treatment option in patients with persistent subfoveal fluid on optical coherence tomography and incomplete recovery of preoperative visual acuity.

Surgical experience and outcome of scleral buckling procedures in retinal detachment

Abstract Purpose The purpose of this study was to evaluate the impact of the surgeons' experience on the anatomical and functional outcome of primary scleral buckling surgery in rhegmatogenous retinal detachment. Methods The charts of patients presenting with a retinal detachment between 2000 end 2006 were analyzed retrospectively. All patients with macular involvement treated with scleral buckling surgery were included. The surgeons were designated according to the “on call” list. Junior surgeons were fellows with less than 2 years of experience, physicians with more than 2 years of experience were defined as senior surgeons. Results Among the 115 included patients, 76 (65,8%) were operated by senior surgeons. The age, duration of symptoms, initial visual acuity, extension of the retinal detachment were similar in both groups. The primary reattachment rate was 87,7% in the senior surgeon group versus 92,1% in the junior surgeon group (p=0,36). In the eyes operated by senior surgeons, the final visual acuity was better than 20/40 in 78,5% versus 63,2% in eyes operated by junior surgeons (p=0,09).However, in phakic eyes with limited retinal detachments, the senior surgeons achieved better functional results (p&lt;0.01). Conclusion The surgical experience, except in some subgroups of patients, did not significantly influence the anatomical or the functional overall outcome of patients undergoing primary scleral buckling surgery in retinal detachment with macular involvement.

Submacular fluid after surgery for rhegmatogenous retinal detachment

To evaluate the accumulation of submacular fluid after surgery for retinal detachment. It was a case control study. Sixty seven eyes of sixty six patients with rhegmatogenous retinal detachment which had undergone par plana vitrectomy (PPV) or buckle surgery for retinal detachment were recruited. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macular at the 1-month postoperative follow-up examination. Submacular fluid after PPV occurred in 21.7% eyes, and was significantly lower than that after buckle surgery(47.7%, chi2 = 4.296, P < 0.05). No significantly differences of submacular fluid rate were found between different surgical technique groups (cryotherapy, transscleral diode photocoagulation, with or without drainage of subretinal fluid) in our buckle surgery series (chi2 = 0.091, 1.588; P > 0.05). There was statistically significant difference in the rate of submacular fluid in cases of buckle surgery series with or without macular detachment (chi2 = 9.537, P < 0.01). Visual acuity improved for 2 lines or more accounted for 80.8% eyes in patients with submacular fluid and for 80.1% eyes in patients without submacular fluid. Comparison of pre- and postoperative LogMAR between these two groups showed no significant difference (F = 0.162, P = 0.688). The rate of submacular fluid is much lower after PPV than after buckle surgery. Different surgical techniques used in buckle surgery such as cryotherapy or transscleral diode photocoagulation and with or without drainage of subretinal fluid do not influence the rate of postoperative submacular fluid. The rate of submacular fluid is much lower in eyes without macular detachment than in eyes with macular detachment in buckle surgery series.

Extrusion and Infection Incidence in Scleral Buckling Surgery with the use of Silicone Sponge: To Soak or not to Soak? An 11-Year Retrospective Analysis

To assess the incidence of extrusion and infections of encircling silicone sponges in scleral buckling surgery for retinal detachment with and without the use of an intraoperative antibiotic soaking procedure. The authors performed a retrospective analysis reviewing the charts of 1127 patients who underwent episcleral buckling surgery operated by the same surgeon in three different institutions during a period of 11 years. The authors reviewed the charts of patients treated with a single episcleral silicone sponge (Labtician) indentation in three different models. The infection prophylaxis on the operating field was the same in all cases and only since February 1997 was the silicone sponge preoperatively treated with an antibiotic soaking procedure. No immediate postoperative infections were reported in the operated eyes. Three eyes had an implant extrusion and in all these cases silicone sponge removal was performed. All three extrusion cases developed when sponge soaking was not adopted. The data indicate that the soaking procedure does not decrease extrusion and infection incidence in scleral buckling surgery when both accurate surgical technique and disinfection prophylaxis are performed.

Subretinal abscess after scleral buckling surgery: a rare risk of retinal surgery

Case report: Intraocular infections after scleral buckling surgery for retinal detachment are very rare.Comments: We document, on ultrasound B-scan, a rare case of subretinal abscess after scleral buckling surgery.

Optical Coherence Tomography Analysis of the Macula after Scleral Buckle Surgery for Retinal Detachment

To define the incidence, pattern, duration, and clinical consequences of persistent localized submacular fluid after scleral buckle surgery for retinal detachment (RD). Prospective observational cohort series. Ninety-eight patients were identified and recruited to the study. Patients aged > or =18 years undergoing scleral buckle surgery for uncomplicated primary RD over an 18-month period were recruited. All patients underwent clinical examination and optical coherence tomography (OCT) scan of the macula preoperatively and at 6 weeks postoperatively. Those patients who had an abnormality on OCT 6 weeks after surgery underwent follow-up with repeat of the study investigations at 3, 6, 9, 12, and 18 months after surgery until the abnormality resolved. If no abnormality was seen at the 6-week examination, no further investigation was undertaken. Presence of submacular fluid on OCT 6 weeks after surgery. Other outcome measures were duration of persistent fluid and associations with poor visual outcome, type, or duration of detachment. Of the 98 patients recruited into the study, 54 (55%) had subretinal fluid (SRF) on OCT 6 weeks after surgery. We identified 3 patterns of submacular fluid: confluent fluid, a single discrete bleb of fluid, and multiple blebs of fluid. Fluid was associated with delayed visual recovery. Of those with SRF, 78% had persistent fluid at 6 months; resolution of fluid took a median of 10 months and was associated with an improvement in vision. Optical coherence tomography is a useful noninvasive diagnostic method that can detect SRF not seen on clinical examination. Persistent SRF 6 weeks after scleral buckle surgery occurs in approximately half of patients, may persist for many months, and can cause delayed visual recovery.

A study on posterior corneal surface after scleral buckling surgery for retinal detachment

目的 探讨巩膜环扎术后早期角膜后表面的改变.方法 前瞻性研究21例(21眼)非复杂性孔源性视网膜脱离巩膜环扎术.所有患眼均采用巩膜宽环扎联合氪激光光凝封闭视网膜裂孔.手术前后应用Orbscan Ⅱ-3.00 E角膜地形图系统进行检查,测量角膜后表面屈光力.结果 术后1周3 mm区、5 mm区角膜后表面屈光力变化均不明显(P＞0.05).术后1周3 mm区、5 mm区角膜后表面散光度比术前均有显著性增大(P＜0.05).结论 巩膜环扎术后早期角膜后表面散光度增加,但角膜后表面形态改变微小。

Corneal topographic changes after retinal detachment surgery.

To evaluate the changes in corneal topography after scleral buckling surgery for retinal detachment. Twenty-one eyes of 21 patients with the diagnosis of retinal detachment were included in this prospective study. Scleral buckling surgery was performed on all patients. The corneal topography of each was measured before surgery and at 1 week and 1 and 6 months after surgery by computer-assisted videokeratoscopy using the EyeSys 2000 Corneal Analysis System. Changes in corneal videokeratographies were analyzed using the Holladay Diagnostic Summary (HDS) software package. A statistically significant central corneal steepening (average, 1.8 diopter) was noted 1 week after surgery. The total and irregular astigmatic components both revealed a significant but transient increase in the first postoperative month. All these topographic changes persisted for as long as 6 months but returned to preoperative values afterward. Scleral buckling was found to induce transient changes in corneal topography producing both myopia and corneal astigmatism. Videokeratography is helpful for documenting such corneal changes after scleral buckling surgery for retinal detachment.