Conventional Scleral Buckling Research Articles

Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle.

To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using a novel foldable capsular buckle (FCB). This was a series of case observation studies. Eighteen patients (18 eyes) who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included. The procedure was similar to conventional scleral buckling, while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad, external indentation instead of the silicone buckle. The retinal reattachment rate, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive dioptre and astigmatism degree, and complications were evaluated and recorded. There were 7 males and 11 females aged 19-58y. The average time course of RRD was 12d, ranging from 7-20d. The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes, with macula-off detachments in 12 eyes. The patients were followed-up for at least 6mo. The final retinal reattachment rate was 100%. The BCVA was significantly improved compared with the baseline (P<0.05). There was no significant change in refractive dioptre or astigmatism degree at each follow-up (all P>0.05). Three patients had transiently high IOPs within one week after surgery. Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed. The success rate of FCB scleral buckling for RRD is satisfactory. This procedure can be expected to be applied in new, uncomplicated cases of RRD.

Simplified segmental scleral buckling without localization and cryopexy: A retrospective comparison with conventional segmental scleral buckling

Abstract: PURPOSE: The aim of this study was to propose a simplified segmental scleral buckling (SSSB) technique that does not require break localization for less-experienced vitreoretinal surgeons. MATERIALS AND METHODS: This retrospective study compared the clinical results of 46 conventional and 23 SSSB (conventional segmental SB [CSSB] and SSSB, respectively) procedures in a tertiary referral retinal center in Taiwan between 2008 and 2019. In the CSSB group, breaks were localized during surgery. In the SSSB group, a wider sponge band and a longer scleral buckle were used to maximize the chances of sealing the retinal breaks based on the preoperative fundus examination findings and to minimize the positioning error caused by cyclotorsion, without performing indirect ophthalmoscopy. The primary outcome was assessed after 6 months. Patient characteristics, surgical parameters, and outcomes were compared between groups. The main outcomes were the duration of surgery, changes in visual acuity, primary success rate, rhegmatogenous retinal detachment recurrence rate, and the frequency of further laser photocoagulation. RESULTS: SSSB had a shorter duration than CSSB and was associated with more frequent use of longer and wider explants and need for further laser retinopexy. Both groups showed high primary success rates (95.65%). CONCLUSION: The primary success rates for the SSSB and CSSB groups were comparable and equally high. SSSB required laser retinopexy more frequently and was a shorter procedure.

Efficacy of Novel Endoillumination Assisted Modified Scleral Buckling versus Conventional Scleral Buckling

Scleral buckling (SB) has proven to be an effective surgical technique for RRDs especially in patients with uncomplicated rhegmatogenous retinal detachment (RRD) not associated with proliferative vitreoretinopathy (PVR). Until recently, it was still the most commonly employed surgical technique in dealing with RRDs with a high success rate. with the advent of the modern retinal viewing systems and vitrectomy machines, the trends in dealing with RRD are more inclining towards pars plana vitrectomy. Possible reasons for it are that conventional SB has steeper learning curve and it is assisted by the Indirect ophthalmoscope to view the retina during various steps of the surgery which has smaller inverted image and also its use is cumbersome. with the novel techniques being introduced, the essence of scleral buckling can be preserved and the surgical technique can be made much easier by providing a better viewwith easy localization of retinal breaks. The basic principles and steps of conventional scleral buckling can be well taught and more effectively practiced with the introduction of better illumination and viewing systems. In this study, the efficacy of endoillumination source assisted modified scleral buckling would be determined and compared with the results of conventional scleral buckling. Objective: To compare the functional and anatomical success rates of conventional scleral buckling for RRD with endo-illumination assisted Wide angle viewing system modified scleral buckling in patients with uncomplicated rhegmatogenous retinal detachment. Materials and Methods: This is an interventional prospective study being conducted at the Department of Ophthalmology, Peshawar Medical College (PMC) and Allied hospitals from July 1, 2020 to December 31, 2020. The study included 40 patients presenting with uncomplicated RRD, 20 in each group, by simple random sampling technique. Outcome measures assessed were primary visual acuity (VA), primary anatomical success, and peri-operative complications. Results: 40 patients (40 eyes) were recruited in this study, 20 in each group (conventional scleral buckling group and modified scleral buckling group), who completed a 3 months follow up. 21 (52.5%) were male patients while 19 (47.5%) patients were female. Mean age was 44.3 ± 12.1. New retinal breaks were identified in 3(15%) patients in the MSB group. Retinal reattachment was achieved in 95% patients in both the groups. Cataract Progression was later found in 1(5%) patient in the MSB group. No other complications were recorded in either of the comparative groups. 1(5%) patient each, in both the groups, underwent additional surgeries. Conclusion: In conclusion, the endolight-assisted scleral buckling using a wide angle visualization system appears to be a promising technique with comparable surgical outcomes to conventional scleral buckling with least complications in specific cases of rhegmatogenous retinal detachment. It can be safely used to meet the surgical need and reduce discomfort during surgery. It is particularly useful in cases with pre-operatively undetected retinal tears. Wide angle viewing system assisted modified scleral buckling technique is highly recommended for teaching purposes. Keywords: Scleral buckling; Wide angle viewing system, Rhegmatogenous retinal detachment, Modified scleral buckling.

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment.

Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.

Non-contact wide-angled visualization with chandelier-assisted scleral buckling for primary uncomplicated rhegmatogenous retinal detachment.

To report our experience in non-contact wide-angled visualization with chandelier-assisted scleral buckling (SB) in uncomplicated primary rhegmatogenous retinal detachments (RRD). Retrospective case series of 282 eyes that underwent non-contact wide-angled visualization with chandelier-assisted SB and were followed for a mean of 13.5 months. There were 160 male patients. The average age was 42.6 years old. There were 262 eyes that were phakic, 18 pseudophakic, and 2 aphakic. Two-thirds of eyes presented with the macula detached. Eyes had an average of 1.6 breaks. The single operation anatomic success rate was 85.1% (240/282). The pre-op visual acuity improved from 1.21 to 0.76 logMAR at 6 months (p < 0.0001). Complications included a case of scleral laceration, choroidal hemorrhage, 3 epiretinal membranes, 1 macular fold, and 4 eyes with buckle exposure. Non-contact wide-angled visualization with chandelier-assisted SB compares favorably with conventional SB for primary uncomplicated primary RRD.

Endo-Illumination-Aided Scleral Buckling Combined with Intravitreal Injection of Hyaluronate for Treatment of Rhegmatogenous Retinal Detachment

Purpose: To evaluate the efficacy and safety of 25-gauge illumination-aided scleral buckling (SB) combined with hyaluronate injection for the treatment of rhegmatogenous retinal detachment (RRD). Methods: Forty-five cases were included in this retrospective study. Twenty-five cases of the treatment group received SB with the aid of endo-illumination and noncontact wide-angle viewing system combined with hyaluronate injection after subretinal fluid drainage, while 20 cases of the control group received conventional SB with binocular indirect ophthalmoscope combined with air injection. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and complications were observed and recorded. Results: The mean operation duration of the treatment group (42.06 ± 16.77 min) was significantly shorter than that of the control group (50.19 ± 21.61 min, p = 0.042). Only 1 case of the control group underwent a second surgery, and the final reattachment ratios of the 2 groups were both 100%. BCVA improved in both the treatment group (from 0.91 ± 0.79 to 0.42 ± 0.58 logMAR, p < 0.001) and the control group (from 0.82 ± 0.70 to 0.41 ± 0.37 logMAR, p = 0.001). The improvements of BCVA of the treatment group and control group were –0.49 ± 0.38 and –0.42 ± 0.46 logMAR, with no significant difference (p = 0.594). There was no significant difference in IOP and complications between the 2 groups. Conclusions: 25-gauge endo-illumination-aided SB combined with hyaluronate injection was safe and effective for RRD.

Materials Used in Conventional Retinal Detachment Surgery and Properties

The main fulcrum of the Conventional Retinal Detachment (RD) surgeon is to reattach the retina by reducing the vitreoretinal traction with the technique of externally collapsing the sclera. Conventional RD or scleral buckling surgery with a long history, there are two basic methods in which explants and implants are used. Nowadays, the more commonly used method is explanted. Basic features of explant material to be used in scleral buckling surgery; ease of surgical manipulation, effective collapse, and minimal tissue side effects. These explant materials can be used separately as permanent and absorbable (temporary) materials. Silicone biomaterial from these explants appears to be the most appropriate option and is considered the gold standard.

Preoperative estimation of distance between retinal break and limbus with wide-field fundus imaging: Potential clinical utility for conventional scleral buckling.

ObjectiveAccurate scleral marking of retinal breaks is essential for successful scleral buckling. This study aimed to investigate the use of wide-field fundus images obtained with an Optos for preoperative estimation of the distance from the limbus to the retinal breaks.Methods and analysisThis is a retrospective review of 29 eyes from 26 patients with rhegmatogenous retinal detachment who received scleral buckling with anatomically successful repair. They underwent wide-field fundus photography with Optos California. In the pre- and postoperative fundus images, we measured distances from the macula to the retinal tears (TM), to the center of the vortex veins (VM), to the optic disc (DM), and to the posterior edge of the scleral buckle (BM).Results(BM—VM) / DM was significantly correlated with the distance from the limbus to the posterior edge of the scleral buckle that had been determined intraoperatively. (r = 0.705; p<0.001) We applied a regression line derived from this correlation with the value of (TM -VM) / DM in order to calculate estimated distances between retinal breaks and the limbus. The calculated distances were all within the range of distances from the limbus to the anterior and posterior edges of the scleral buckles.ConclusionPreoperative analysis of Optos images may be useful for estimating the distance from the limbus to retinal breaks, which might aid scleral marking during scleral buckling surgery.

Comparative study between conventional scleral and suprachoroidal buckling in management of primary rhegmatogenous retinal detachment

Aim The aim of the work was to compare the anatomical and visual outcomes of conventional scleral buckling with suprachoroidal buckling in the management of uncomplicated primary rhegmatogenous retinal detachment with peripheral retinal breaks. Method A prospective randomized interventional case series of 30 cases of Primary uncomplicated rhegmatogenous retinal detachment with peripheral retinal breaks. Patients were equally distributed into two groups. Group A managed with conventional scleral buckling with 360 circumferential or Localized buckles. Group B managed with suprachoroidal buckling with injection of sodiumhyaluronate14 mg/ml into the suprachoroidal space using specially designed cannula. Results In group A,13 cases out of 15 achieved single-surgery attachment with success rate of 86% compared to12 out of 15 cases in group B with attachment rate of 80%. No statistical significance was found between the two groups.With respect to functional success,the visual acuity of patients of scleral buckling improved from a mean of 0.08±0.08 preoperatively to 0.33 to 0.33±0.22 postoperatively. Patients underwent suprachoroidal buckling improved from a mean of 0.12±0.11 preoperativelyto 0.36 to 0.36 to 0.36 to 0.36±0.19 postoperatively. Significant myopic shift was noted in patients of scleral buckling of mean of −2.48±0.83 D as compared with −0.58±0.56 D in suprachoroidal buckling. Conclusion Suprachoroidal buckling technique shows non inferior results in management of cases of Primary rhegmatogenous retinal detachment in comparison with scleral buckles,with suprachoroidal buckling less changes in refraction as compared with scleral buckles.

25G intraocular illumination aided scleral buckling for treatment of rhegmatogenous retinal detachment

Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P>0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P<0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective. Key words: Retinal detachment/surgery; Scleral buckling

Comparison between the scleral buckling under wide-angle viewing systems and conventional scleral buckling for the treatment of rhegmatogenous retinal detachment

Objective To compare the efficacy between the scleral buckling under wide-angle viewing systems (WAVS) and conventional scleral buckling for rhegmatogenous retinal detachment. Methods The data of 108 eyes of 108 patients with rhegmatogenous retinal detachment was collected and retrospectively analyzed. All cases were randowly divided into two groups: 54 eyes underwent scleral buckling under WAVS (Group A), and 54 eyes underwent conventional scleral buckling under indirect ophthalmoscope (Group B). Preoperatively, the difference were not statistically significant between the two groups in age, gender, course of disease, best corrected visual acuities (BCVA), IOP, refractive error, the extent of retinal detachment, with or without macular detachment, subretinal demarcation line and the number of retinal breaks. The follow-up period was 12 months. Results Durations of operation, primary operative success rate, BCVA and complications were compared between the two groups. The durations of operation in Group A (with or without encircling operation) were obviously shorter than those in Group B (t=-12.735, -18.037; P=0.000, 0.000). The primary operative success rate was 94.44% in Group A and 92.59 %in Group B, the difference was not statistically significant (χ2=0.026, P=0.917). The BCVA in Group A was better than that in Group B (P<0.001) at 1 month after surgery. However, the difference was not statistically significant between the two groups at 3 (t=-1.202, P=0.214), 6 (t=-0.084, P=0.657), and 12 monthes (t=-1.216, P=0.355) follow-up visits respectively. Conclusion The efficacy of scleral buckling under WAVS is good with shorter operative time. It may be an alternative choose for rhegmatogenous retinal detachment. Key words: Retinal detachment, rhegmatogenous; Scleral buckling; Wide-angle viewing systems

A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland.

BackgroundRhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV).MethodsThis is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively.ResultsEyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures.ConclusionPPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD.

Scleral Buckling Using a Non-contact Wide-Angle Viewing System with a 25-Gauge Chandelier Endoilluminator.

PurposeTo report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator.MethodsRetrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination.ResultsThe patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached.ConclusionsScleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.

Scleral buckling procedure with chandelier illumination for pediatric rhegmatogenous retinal detachment.

PurposeTo assess the treatment of pediatric patients with rhegmatogenous retinal detachment (RRD) by scleral buckling with chandelier illumination.MethodsThree eyes were treated in three patients, healthy boys aged 7 years, 12 years, and 11 years, with RRD, macular involvement, and small retinal holes, of which two were preoperatively undetectable. Conventional scleral buckling with cryoretinopexy was performed under the contact lens for vitreous surgery or noncontact wide-angle viewing system using 27-gauge twin chandelier illumination.ResultsThe only known predisposing factor for retinal detachment was myopia stronger than 3 D with lattice retinal degeneration in two of the three patients. Retinal reattachment was achieved in all cases without intra- or postoperative complications. However, visual recovery was limited in one of the three patients.ConclusionScleral buckling with chandelier illumination is effective for pediatric RRD, especially if the retinal hole is difficult to detect preoperatively. However, visual recovery was sometimes limited because of macular involvement due to late diagnosis, which is one of the characteristic features of pediatric RRD.

Yırtıklı Retina Dekolmanının Görme Prognozu Tahmininde Multifokal Elektroretinografinin ve Optik Koherens Tomografinin Katkıları

Objective: To determine the contribution of multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in predicting the visual outcome in patients with macula-off retinal detachments. Material and Methods: Thirthy-seven eyes of 37 patients who had undergone conventional scleral buckling surgery with the diagnosis of macula-off retinal detachment were included in this prospective study. The fellow eyes of the patients served as the control group. Each study participant underwent a comprehensive ophthalmological examination and mfERG recordings were obtained preoperatively and postoperatively. Preoperative height of macular detachment (HMD) and scans of the fovea were assessed with OCT. Results: P1 and N1 amplitude responses of mfERG improved significantly in postoperative period (p<0.001). However, statistical analysis showed that both postoperative P1 and N1 amplitudes were significantly lower than the control group (p<0.001). Preoperative amplitudes of P1 of the summed mfERG showed positive (r=0.34, p=0.042) correlation with best corrected visual acuity (BCVA) levels at 6th month of follow-up. Preoperative BCVA was positively correlated to preoperative intensity of P1 response of concentric ring 1+2 (r=0.38, p=0.020) and P1 amplitudes of the total stimulated area (r=0.47, p=0.003). Preoperative changes of the foveal structure (r=-0.39, p=0.019) and HMD (r=-0.54, p=0.001) showed negative correlation with BCVA levels measured at the 6th month of follow-up. No correlation was found between postoperative BCVA and both the duration of macular detachment and preoperative BCVA. Conclusion: Preoperative assessments of OCT and mfERG in rhegmatogenous retinal detachment may provide valuable prognostic data regarding the postoperative visual outcome.

DIPLOPIA WAS NOT PREDICTABLE AND NOT ASSOCIATED WITH BUCKLE POSITION AFTER SCLERAL BUCKLING SURGERY FOR RETINAL DETACHMENT

The possibility of postoperative binocular diplopia is seen as an important drawback of conventional scleral buckling surgery for rhegmatogenous retinal detachment. The goal of this study was to evaluate the occurrence and pattern of binocular diplopia after scleral buckle procedures in patients with rhegmatogenous retinal detachment. In a retrospective study of 1,030 patients with primary rhegmatogenous retinal detachment who were treated by scleral buckle surgery between January 2001 and July 2008, the postoperative occurrence of binocular diplopia was retrieved from the medical charts. Secondary strabismus developed in 39 subjects (3.8%) after scleral buckle surgery during a mean follow-up of 6.4 ± 6.3 months. Twenty-eight patients (2.7%) developed strabismus because of a mechanical restriction of one of the muscles. No association was found between the position of the buckle, that is, the muscle affected, and the incidence of diplopia. A moderate significant association was found when two muscles were affected with a higher incidence of diplopia. This was, however, not found for three or more muscles. In 28 of 39 patients, binocular single vision was restored at the end of the follow-up period. In the majority, this was accomplished with conventional prism treatment. Strabismus caused by a restriction of the muscles in scleral buckle surgery was not predictable based upon the buckle position. Patients with a minimal restriction of the muscles after scleral buckle surgery can often be well treated with prisms.

The effect of a preoperative subconjuntival injection of dexamethasone on blood–retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial

BackgroundBlood–retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood–retinal barrier breakdown postoperatively.MethodsProspective, placebo-controlled, double blind clinical trial. In 34 patients with rhegmatogenous retinal detachment scheduled for conventional scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5 ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5–6 hours before surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and 6 weeks after randomisation between dexamethasone and placebo were analysed using mixed model ANOVA, while correcting for the preoperative flare measurement.ResultsSix patients did not complete the study, one because of recurrent detachment within 1 week, and five because they missed their postoperative laser flare visits. The use of dexamethasone resulted in a statistically significant decrease in laser flare measurements at the 1-week postoperative visit.ConclusionThe use of a preoperative subconjunctival injection of dexamethasone decreased 1-week postoperative blood–retina barrier breakdown in patients undergoing conventional scleral buckling retinal detachment surgery. This steroid priming could be useful as a part of a peri-operative regime that would aim at decreasing the incidence of PVR.

Vitrectomy cryo gas for the treatment of pseudophakic retinal detachment

Abstract Purpose The management of pseudophakic rhegmatogenous retinal detachment (PsRD) has represented a challenge for vitreoretinal surgeons for many years. Different surgical techniques have been used to manage PsRD including pneumatic retinopexy, scleral buckling (SB) and primary pars plana vitrectomy (PPV) with or without SB. Recent advances in the vitrectomy technique and instrumentation have contributed to the expanding role of PPV as a first‐line surgical treatment in cases of PsRD. Methods A potential advantage of PPV is removal of posterior capsular and vitreous opacities for better visualisation of the peripheral retina and the use of wide‐angle viewing systems and microscopic inspection of the fundus periphery with internal illumination and scleral identation during PPV. This allows for an accurate diagnosis of retinal breaks, their prompt treatment and thus high initial anatomical success. Results A meta‐analysis of published studies suggested that PPV with or without SB is more likely to achieve favorable anatomical and visual outcomes than conventional scleral buckling alone in uncomplicated PsRD. Recently published prospective or randomized clinical trials also found that primary PPV alone is at least as effective as scleral buckling for the treatment of PsRD. The Scleral Buckling versus Primary Vitrectomy in Rhematogenous Retinal Detachment study, found no difference in visual acuity between PPV and SB alone in pseudophakic eyes, but anatomic outcomes were better in the PPV group. Conclusion Primary vitrectomy without scleral buckling provides a high anatomic success rate in eyes with PsRD and is associated with few complications.

Comparison of Results of Cryopexy and Laser Indirect Ophthalmoscopy in Rhegmatogenous Retinal Detachment

Purpose: To compare the efficacy and safety of intraoperative laser indirect ophthalmoscopy and cryopexy for rhegmatogenous retinal detachment through the use. Methods: We retrospectively analyze the clinical results of 60 patients (61 eyes) with rhegmatogenous retinal detachment. All eyes had an attached macula and were scheduled for conventional scleral buckling surgery with cryopexy (25 eyes) or laser indirect ophthalmoscopy (36 eyes) from March 2001 to August 2007. The visual acuities of the two groups at the first postoperative day, 1 week, 1 month, and 3 months were compared. Retinal reattachment, macular pucker, cystoid macular edema, and proliferative vitreoretinopathy were confirmed 3 months after surgery. Results: The visual recovery was faster in patients who received laser indirect ophthalmoscopy (1 day, P=0.044; 1 week, P=0.017). During the follow-up period, anatomical failure in the laser indirect ophthalmoscopy group did not develop, but there were two anatomical failures in the cryopexy group. In addition, 1 PVR was detected in the cryopexy group. However, neither group exhibited macular pucker or cystoid macular edema. Postoperative additional laser photocoagulation was performed on 7 eyes (19.4%) in thelaser indirect ophthalmoscopy group and 2 eyes (4.0%) in the cryopexy group. Conclusions: Although intraoperative laser indirect ophthalmoscopy causes less chorioretinal scar formation than cryopexy, it has a higher anatomical success rate and allows for faster visual recovery.

Résultats chirurgicaux des décollements de rétine sans déhiscence visible

The treatment of retinal detachment (RD) with unseen breaks has not been clearly defined. The aim of this study was to evaluate surgical results of these RDs using two different techniques. We conducted a retrospective study including consecutively operated RDs in our department between 2001 and 2006. Twenty-two RDs were identified. In eight eyes (36.4%), conventional scleral buckling was performed (with or without subretinal fluid drainage). In 14 eyes (63.6%), vitrectomy associated with cryopexy or endolaser impact was performed. Circumferential buckling was achieved in ten cases. These operated patients account for 2.5% of the RDs followed up in our department between January 2001 and June 2006 (887 patients). The eyes were predominantly pseudophakic (86.4%), with inferior RD (59.1%). The patients had described functional signs for a mean of 56 days (2-240 days). Sixteen eyes (73%) were reattached after the primary procedure. The primary reattachment rates at 1 month were 37.5% in the scleral buckling group versus 86.4% in the vitrectomized group. The final retinal reattachment rate was 86.4%. In our study, the situation where breaks are unseen during retinal detachment surgery is uncommon (2.5%), occurring most often with inferior retinal detachment in pseudophakic eyes. This seems to indicate better retina reattachment after vitrectomy associated with a circumferential buckling in first intention. However, a study including a larger number of patients would be necessary to confirm our results.