Scleral Buckling For Rhegmatogenous Retinal Detachment Research Articles

A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization.

PurposeThe guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP).MethodsA retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16).ResultsThe single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0–0.20) in the ID group and 0.08 (0.02–0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94–123) minutes in the ID group and 100 (90–111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100–135) minutes vs 93 (85–111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group.ConclusionCompared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.

360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes

BackgroundTo determine patient and surgical factors associated with the use of 360-degree laser retinopexy during primary pars plana vitrectomy (PPV) ± scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes.MethodsPatients who underwent PPV ± SB for repair of non-complex RRD at a single centre were included in this retrospective study. The primary outcome was single surgery anatomical success (SSAS). Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. Multiple logistic regression and multivariate regression was used.ResultsThe study included 192 cases, of which 130 received 360-degree laser. Worse preoperative logMAR visual acuity (P = 0.009), male sex (P = 0.060), higher PVR grades, supplemental SB (P = 0.0468) and silicone oil/C3F8 tamponade (P < 0.0001) were associated with 360-degree laser use. No significant associations between 360-degree laser and SSAS (P = 0.079), final logMAR visual acuity (P = 0.0623), ERM development (P = 0.8208), postoperative CMO (P = 0.5946), tonic pupil (P > 0.9999) or corneal epithelial defects (P = N/A) were found.Conclusions360-degree laser retinopexy during primary PPV ± SB for RRD was associated with more complex cases and more extensive operations. Even when accounting for this, there was no difference in surgical outcomes or complication rates.

Corneal Biomechanical Response Alteration After Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

To compare the corneal biomechanics of eyes that underwent scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) with those of fellow eyes (fellow eyes) and to further investigate the effects of SB on intraocular pressure (IOP) values. Retrospective, fellow-eye matched cohort study. A total of 18 consecutive patients (11 males and 7 females) treated with SB for RRD in 1 eye were enrolled. Goldmann applanation tonometry was used to measure IOP. Biomechanical properties of the cornea were investigated by using the Ocular Response Analyzer (ORA) (Reichert Instruments) for the calculation of corneal resistant factor (CRF), corneal hysteresis, Goldmann-correlated IOP, and corneal-compensated IOP. Customized software was used for analysis of the ORA infrared and pressure signals, and a significance threshold was set to a P value of .05. Operated eyes (OEs) showed significantly lower values of corneal hysteresis and CRF than fellow eyes (9.0 ± 1.8 vs 10.1 ± 1.8mm Hg, respectively; P < .001; 10.0 ± 2.2 vs 10.9 ± 2.2mm Hg; P < .001). GAT was significantly lower than corneal-compensated IOP in OEs (18.1 ± 4.9 vs 19.8 ± 4.8mm Hg, respectively; P= .022) but not in fellow eyes. The second applanation event (A2) took place earlier in time, and the cornea was moving faster during A2 in the OEs than in the fellow eyes. SB for the treatment of RRD affects corneal biomechanical response, likely due to a less compliant sclera that limits corneal motion and reduces energy dissipation, reflected in a lower corneal hysteresis. This has potentially meaningful clinical implications as the accuracy of the measurement of IOP values may be affected in these eyes.

FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4).

To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.

Anatomical and functional outcome of scleral buckling in primary rhegmatogenous retinal detachment

Purpose: To study the anatomical and functional outcomes, complications and reasons for failure of scleral buckling in primary rhegmatogenous retinal detachment Design: Prospective Observational Study Materials and Methods: 17 eyes of 16 consecutive patients who had undergone scleral buckling for rhegmatogenous retinal detachment at a tertiary care teaching Ophthalmic Institute in South India from January 2015 were taken up for the study. Important points like history of trauma, spectacle use and cataract surgery were noted from the history. Detailed evaluation including snellen visual acuity converted to Logmar vision, Slit Lamp Evaluation, Fundus examination, Applanation tonometry etc were done and documented before surgery and the same parameters were again noted during the follow up examinations on the first post operative day and then at 2 weeks, 4 weeks, 3months and 6 months. Surgical parameters like number and location of breaks, macular status, type of buckling etc were also recorded diligently. Results: 15 Out of the 17 eyes (88%) achieved anatomical success with the retina attached at 4 weeks of post operative follow up. The cause of failure in the remaining 2 cases was missed retinal breaks and were rescued by vitrectomy. The mean average pre operative vision was 2.23 which improved to a mean average vision of 1.49, 1.30, 1.15, 1.04, 1.01 at 1st post operative day, 2weeks, 4 weeks, 3months and 6 months respectively. The change was found to be significant. The macula on RRDs (4 eyes) had better visual improvement with mean pre op Logmar vision improving from 0.842 to a post op Logmar vision of 0.37 and 0.15 at 4 weeks and 6 months respectively. Conclusions: Scleral buckling provides a reasonably good anatomical outcome in properly selected cases of primary rhegmatogenous retinal detachment. It also provides a moderate visual outcome. The post operative visual outcome depends mainly on the pre operative status of macula. The main cause for failure of sclera

Scleral buckle surgery in Ghana: a decade comparison of the anatomic and visual outcome.

PurposeTo compare the anatomic and visual outcome of scleral buckle (SB) surgery in Korle Bu Teaching Hospital between 2002 and 2005 and 2011 and 2014.Materials and methodsIn this retrospective comparative study, the medical records of patients who have undergone SB for rhegmatogenous retinal detachment from January 2002 to December 2005 (group A) and from January 2011 to December 2014 (group B) in Korle Bu Teaching Hospital were examined. The clinical history, surgical techniques, and outcomes of treatment were analyzed. The main outcome measures were primary anatomic success (retina reattached for at least 3 months postoperatively after a single procedure), overall anatomic success (combined primary anatomic success and success following revision of SB with at least 3 months follow-up), mean postoperative best-corrected visual acuity (BCVA), and complications.ResultsOne hundred fifty-eight eyes (71 eyes in group A and 87 eyes in group B) were treated with SB in this study. The mean duration of rhegmatogenous retinal detachment was 105.5 days. Thirty-four (21.8%) of fellow eyes had BCVA worse than 6/60 at presentation. The primary anatomic success was comparable between the two groups; 70% in group A and 67.9% in group B (P=0.79). The overall anatomic success was also comparable between the two groups (76.7% in group A vs 79.8% in group B) (P=0.788). The mean postoperative BCVA in logMAR was significantly better than the mean preoperative BCVA (P<0.0001). Group B had significantly better mean BCVA (P=0.002) and longer duration of follow-up (P<0.0001) compared with group A at the last follow-up visit.ConclusionThe anatomic success of SB between the two time periods was comparable. A longer postoperative duration of follow-up was associated with a better visual outcome after SB.