Scleral Buckle Placement Research Articles

Risk factors for receiving both scleral buckle and glaucoma drainage device in children

We conducted a retrospective review of patients (< 18 years) between 2013 and 2021 to determine risk factors of pediatric patients receiving a glaucoma drainage device (GDD) needing a scleral buckle (SB) and vice versa. The first population underwent an SB placement with no prior GDD. The second underwent a GDD implantation with no prior SB. We analyzed 133 eyes in the SB-first group. The common indications were retinal detachment associated with a syndrome/disease (41.2%), blunt trauma (21%), and non-syndromic pathologic myopia (11%). Twelve eyes (9%) required subsequent GDD implantation with a mean time to reoperation of 19.73 months (median 2.3 months). Eyes with trauma had a 5-fold risk (hazard ratio [HR] 4.81, p = 0.0069) of requiring a subsequent GDD. Each additional glaucoma medication before initial SB surgery increased the risk by 1.81 (p = 0.0096). 135 eyes were in the GDD-first group. Four eyes (3%) required a subsequent SB. The mean time to reoperation was 17 months (median 9.2 months). There was a statistically significant association with trauma (HR 12.3, p = 0.0341) only. Pediatric eyes with a history of trauma and/or multiple glaucoma medications before intervention have a high risk of requiring both an SB and GDD.

The Ergonomic Evaluation of Attendings and Trainees Across the Vitreoretinal Service as Measured by a Wearable Device

Background and Objective: A cross-sectional prospective study to examine ergonomic differences in vitreoretinal settings: surgery, clinic, and dedicated procedure clinic. Patients and Methods: Three vitreoretinal surgeons, three fellows, and one resident at a tertiary eye care facility. Participants wore an Upright Go 2 posture device and posture was recorded in each setting between July 1 to August 31, 2023. Results: Time in upright and poor postures was tracked. Significant differences were found in postural score for attendings between work settings ( P &lt; 0.01). Trainees showed no significant difference between settings. Poor posture in surgery was linked to microscope use and scleral buckle placement; in the clinic, it was associated with pan-retinal photocoagulation and injection minutes; in procedure clinic, it was ophthalmologist-dependent and those performing injections. Conclusions: Ergonomic considerations are crucial in vitreoretinal practice. Attendings and trainees should focus on posture in surgery and clinic settings to enhance career longevity. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX–XX.]

Optimal Illumination: The BFF Light

Background: Optimal illumination for procedures performed without the operating microscope remains challenging for the surgeon within some subspecialties. We present a novel device that provides unmatched illumination for such procedures and highlight its use during scleral buckle placement. Methods: A mode of illumination prioritizing precision, flexibility, portability, and compatibility in various procedural settings was developed. Using such a prototype, a proof-of-concept assessment quantified the number of manual light adjustments vs ceiling-mounted spotlight adjustments required during scleral buckle placement. Results: The Brodie-Fekrat Flex (BFF) Light, an ultrabright LED light connected to a flexible gooseneck, can mount on surgical microscopes, wrist-rests, ceiling-mounted spotlight handles, and even exam chairs. During scleral buckle placement, the BFF Light did not require intraoperative re-adjustment once positioned, whereas ceiling-mounted spotlights were repositioned 5 times on average. Conclusions: The BFF light provides reliable, bright illumination during procedures that do not require the operating microscope. This versatile device may also have applications in the clinic setting, even beyond ophthalmology.

Orbital compartment syndrome following primary scleral buckle surgery.

To illustrate a patient with orbital compartment syndrome following scleral buckle placement that was successfully treated with canthotomy and cantholysis. Observational case report. A 26-year-old male underwent a primary scleral buckle repair for a chronic rhegmatogenous retinal detachment. On post-operative day four, the patient presented to the emergency room with pain and increased intraocular pressure (IOP). Initial treatment with conservative IOP lowering agents was unsuccessful. The patient was diagnosed with delayed orbital compartment syndrome and was successfully managed with lateral canthotomy and inferior cantholysis in addition to aggressive steroid and antibiotic medical management. Following scleral buckle placement with sub-tenon's anesthesia block, there may be a delayed presentation of orbital compartment syndrome. Recognition and management of this rare complication is important for preventing irreversible blindness.

Scleral Buckle Removal: Long-Term Patient Outcomes

Scleral buckling has been a reliable treatment option in the repair of primary rhegmatogenous retinal detachments. Occasionally, patients require scleral buckles (SBs) to be removed for various reasons. While outcomes of SB removal have been investigated in this subset of patients, there has not been any large patient series to reach any conclusions. Long-term sequelae of SB removal are debated in the literature, specifically around the risk of redetachment. We performed a retrospective, observational study to evaluate the clinical indications for, and outcomes of, SB removal. No control patients in this retrospective, observational study. Eighty-six individuals with a history of SB removal from June 1, 2000, to January 1, 2021, were followed from a large academic center and a private, retina-only practice in Chicago. Exclusion criteria were age of < 18 years and unplanned or self-explanted SB removal. Data extracted included patient symptoms before SB removal, indications for removal, resolution of symptoms following removal, rate of redetachment, and rate of additional ocular surgery. Secondary outcomes included identifying factors associated with poorer outcomes. Eighty-six eyes with history of SB removal were included with an average follow-up of 4 years. Approximately 60% were males and the mean age at the time of SB removal was 59 years. Leading indications for removal were exposure (61.63%), infection (20.93%), and diplopia/strabismus (19.77%). The average time from SB placement to removal was 12.28 ± 11.16 years. Most patients requiring SB removal presented with symptoms, specifically of pain and discomfort (65.12%), diplopia (22.09%), and drainage/discharge (18.60%). Of these patients, 86.59% experienced symptom resolution following SB removal. Notably, 6.56% (4 eyes) of all eyes with at least 1 year of follow-up experienced a redetachment requiring surgery. Within this subset, the average time from SB placement to removal was 2.05 ± 2.01 years and time to redetachment following removal was 15.95 ± 25.71 months. Nine percent of all eyes required additional strabismus or oculoplastic surgery. Scleral buckle removal provides a high rate of symptomatic relief and low risk of subsequent detachment. Nevertheless, close monitoring is warranted to monitor for recurrent retinal detachments. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Rhegmatogenous Retinal Detachment in Syphilitic Uveitis: A Case Series and Comprehensive Review of the Literature

ABSTRACT Purpose Uveitis is the most common ocular manifestation of syphilis. However, an association between syphilitic uveitis and rhegmatogenous retinal detachment (RRD) is not widely recognized. We report a consecutive series of six new cases of syphilitic uveitis complicated by RRD and describe the typical characteristics, clinical course, and surgical management of such cases. Methods Consecutive case series and comprehensive review of the literature. Results We identified a total of 19 cases (23 eyes) with syphilitic uveitis subsequently complicated by RRD, including six new cases (seven eyes) reported here and 13 cases (16 eyes) previously reported in the literature. Fifteen patients (79%) were positive for human immunodeficiency virus (HIV) and not on combination antiretroviral therapy. Most retinal detachments developed within two months of uveitis presentation; retinal breaks were often found in areas of previous retinitis. Sixteen eyes (70%) were complicated by early proliferative vitreoretinopathy. Twenty-one eyes underwent surgical repair, of which six (26%) suffered re-detachment. Surgical management commonly involved pars-plana vitrectomy and silicone oil tamponade, with or without scleral buckling. Visual outcomes were generally poor: only six eyes (26%) attained visual acuity of 20/40 or better and 11 eyes (48%) remained 20/200 or worse. Conclusions Patients with syphilitic uveitis, as with viral retinitis, should be monitored closely for the development of retinal tears and RRD. A combination of pars plana vitrectomy with silicone oil tamponade and/or scleral buckle placement is a prudent surgical approach to most cases of syphilitic RRD, although visual prognosis remains guarded.

External Subretinal Fluid Drainage in Scleral Buckling: Before Versus after Cryotherapy and Buckle Placement, A Pilot Study

In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. Eight eyes in each group were roughly matched for age, sex, baseline visual acuity (VA), and detachment characteristics. The complication rate was 0% for the "before" group and 37% for the "after" group (p = 0.100). In the "after" group, two eyes (25%) developed iatrogenic retinal holes and one eye (12%) developed self-limited subretinal hemorrhage during external needle drainage. The duration of surgery was significantly shorter for the "before" group (mean 89 ± 16 min) compared to the "after" group (118 ± 20 min) (p = 0.008). The primary anatomic success rate was 100% for the "before" group and 75% for the "after" group (p = 0.233). Final VA was not significantly different between the groups or from baseline. In conclusion, while limited by our small sample size, this pilot study suggests that drainage of subretinal fluid before scleral buckle placement may be safer and more efficient compared to draining after buckle placement. Initial drainage may facilitate retinochoroid apposition to allow targeted cryopexy and precise buckle placement.

Modified scleral band buckle placement technique.

Background:Scleral buckling is considered an art, which has a long learning curve compared to other surgical retina techniques. Unfortunately, this beautiful surgical technique is getting less attention as new retina surgeons don’t get much exposure to this age-old surgical technique, reason being less interest shown by young retina surgeons and tremendous advancement in micro-incision vitrectomy system.This video is a modification of the present technique of placement of band buckle, which uses science rather than art.The most important aspect in band buckle is getting the optimal buckle height which needs a lot of experience before one can achieve it. Most of the surgeons tend to tighten it more than needed that can lead to complications. This new technique is easy to learn and will give controlled reproducible buckle height and can be done safely by the trainees.Purpose:The aim of this video is to simplify the technique of scleral buckling which can produce controlled and reproducible buckle height and will reduce the complications associated with a tight band buckle.Synopsis:A 360-degree peritomy is made. Four recti muscles are identified and separated and traction sutures are passed under their insertions. A partial thickness scleral tunnel is made in all four quadrants. A silicone band (style#41 used in this video) is passed through the scleral tunnel and under the insertion of all four recti.The two ends of the silicone band are trimmed so that they are opposed to each other. Then a 12-mm strip is cut off from one end, and the two remaining ends are tied with a 5-0 nonabsorbable suture. This technique ensures a 2-mm optimal buckle height.Highlights:We present an elegant technique of placing the band buckle in retinal detachment surgery.Video link: https://youtu.be/9_dh6qsd-7A

Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes

To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery. Retrospective observational case series. Eyes that underwent SB removal between 2010 and 2016 with greater than 1 year of follow-up were included. Main outcome measures were post-SB removal complications and best-corrected visual acuity (BCVA). Fifty eyes that underwent SB removal met the inclusion criteria. Indications include exposed SB (54%), infection (26%), diplopia (16%), and recurrent retinal detachment (4%). Mean and median intervals between SB placement and removal were 65 months and 30 months. Complications include recurrent retinal detachment (12%), transient ocular hypertension (6%), and persistent diplopia (4%). There was no significant change in mean BCVA after SB removal (P = .979). Exposed SB, infection, and diplopia are the most common indications for SB removal. The single-surgery success rate is high and the risk for complications is relatively low. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:138-144.].

BUCKLE-ASSOCIATED EPITHELIAL CYST MASQUERADING AS INTRAOCULAR INFLAMMATION

To describe a case of a rare, late scleral buckle-related complication, which was masquerading as ocular inflammation. Case report. A 63-year-old woman with ocular history significant for cataract extraction with intraocular lens placement and retinal detachment repaired through pars plana vitrectomy and scleral buckle presents with anterior chamber inflammation and debris in the left eye. Uveitis workup was negative for any associated systemic disease. Anterior chamber washout and biopsy were nondiagnostic. At postoperative Month 1, she had recurrent anterior chamber debris and new debris noted in the vitreous cavity. A pars plana vitrectomy was performed, and during intraoperative scleral depression, copious strands of whitish material were expressed into the vitreous cavity. The scleral buckle was removed with additional whitish material noted within the encapsulated area. Papanicolaou stain of the material demonstrated a mixture of epithelial cells, histiocytes, lymphocytes, plasma cells, and neutrophils consistent with an epithelial cyst. Epithelial inclusion cysts are a rare complication of scleral buckle placement. These cysts are lined by a nonkeratinized, stratified squamous epithelium with or without goblet cells and most commonly occur after ocular trauma, inflammation, or surgical procedures. To the best of our knowledge, this is the first reported case of erosion of an epithelial inclusion cyst into the vitreous cavity.

Recurrent Orbital Cellulitis Secondary to the ‘Forgotten’ Scleral Buckle: A Case Report

Scleral buckle placement is a well-established technique for the treatment of primary rhegmatogenous retinal detachment. Complications associated with scleral buckle are uncommon and its presentations can be vary. We report a case of recurrent orbital cellulitis with anterior segment ischemia following a forgotten episode of previous scleral buckling surgery, presenting with blurring of vision, redness and swelling of the lids. The presence of scleral buckle was detected by detailed examination and confirmed by orbital imaging. Orbital infection and rubeosis iridis were successfully treated with scleral buckle removal, intravenous antibiotics and intracameral ranibizumab. However, the retinal detachment recurred and the visual acuity deteriorated to light perception. There was no further intervention as the family declined in view of her old age. In cases of recurrent orbital infection, detailed clinical examination is important to look for evidence of ocular prostheses as a source of infection. Orbital imaging is an adjunct for making the diagnosis especially in cases where history is unreliable. Anterior segment ischemia due to scleral buckle responds well to buckle removal with ranibizumab injection.

Modified Controlled Encircling Scleral Buckle for Retinal Detachment.

During encircling scleral buckle placement, the ends of the element are tightened to achieve a shortened radius of the eye. The determining factor of the final buckle height is subjective using usually a combination of the buckle height visualized with the degree of scleral indentation and can be difficult to be taught early on to trainees. Here, we describe a case series in which a modified controlled encircling scleral buckle technique that simplifies and standardizes the achievement of reproducible buckle height of about a 1 mm is objective and easy to be taught. This novel encircling scleral buckling technique successfully achieves a good postoperative scleral buckle height in a reproducible and standardized fashion using objective measurements and it is easier to be taught to trainees.

GoPro HERO 4 Black recording of scleral buckle placement during retinal detachment repair

ObjectiveGoPro and Google Glass technology have previously been used to record procedures in ophthalmology and other medical fields. In this manuscript, GoPro’s latest HERO 4 Black edition camera (GoPro Inc, San Mateo, Calif.) will be used to record the placement of a scleral buckle during retinal detachment surgery. MethodsGoPro HERO 4 Black edition camera, which records 4K-quality video with a resolution of 3840 (pixels) x 2160 (lines), was mounted on a head strap to record placement of a scleral buckle for a retinal detachment. ResultsExcellent video quality was achieved with the 4K SuperView setting. Bluetooth connection with an Apple iPad (Apple Inc, Cupertino, Calif.) provided live streaming and use of the GoPro App. Zoom, horizontal/vertical alignment, exposure, and contrast adjustments were made with postproduction editing on GoPro Studio software. ConclusionsVideo recording with the GoPro HERO 4 Black edition camera is an excellent way to document extraocular procedures to improve medical education, self-training, or medicolegal documentation.

Outcomes of Scleral Buckle Removal: Experience from the Last Decade

ABSTRACTPurpose: To evaluate the indications, outcomes, and complications of scleral buckle removal over the past decade and compare to previously published data.Methods: Forty nine eyes of 49 patients who underwent scleral buckle removal and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, history of the retinal detachment, details of the scleral buckling surgery, indication for scleral buckle removal, time from scleral buckle placement to removal, culture results, length of follow up, visual acuity (VA) throughout the follow up, and the occurrence of any complications or need for additional surgery after scleral buckle removal.Results: The overall rate of scleral buckle removal over the last decade was 5.7% (85/1493). Indications included buckle extrusion (57.1%), infection (8.2%), both (26.5%) eyes, and strabismus and diplopia (8.2%). The median time from scleral buckle placement to removal was 35 months, but in 22.4% of cases the buckles were removed after less than 6 months, and in an additional 22.4% of cases after more than 10 years. The rate of recurrent retinal detachment after scleral buckle removal was 8.2%, with half of the cases occurring within 3 months of the removal.Conclusions: Removal of scleral buckles is associated with a 8.2% risk for redetachment. Redetachment can occur many years following the removal and long-term follow up in these patients is warranted.

Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis.

PurposeTo determine the outcomes in patients with rhegmatogenous retinal detachment (RRD) secondary to viral retinitis.Patients and methodsThis was a retrospective, consecutive, noncomparative, interventional case series of 12 eyes in ten patients with RRD secondary to viral retinitis. Results of vitreous or aqueous biopsy, effect of antiviral therapeutics, time to retinal detachment, course of visual acuity, and anatomic and surgical outcomes were investigated.ResultsThere were 1,259 cases of RRD during the study period, with 12 cases of RRD secondary to viral retinitis (prevalence of 0.95%). Follow-up was available for a mean period of 4.4 years. Varicella zoster virus was detected in six eyes, herpes simplex virus in two eyes, and cytomegalovirus in two eyes. Eight patients were treated with oral valacyclovir and two patients with intravenous acyclovir. Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater. Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.ConclusionVaricella zoster virus was the most frequent cause of viral retinitis, and lack of optic nerve involvement was predictive of a favorable visual acuity prognosis. Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.

RECURRENT HEMOLACRIA

The purpose of this study was to report recurrent hemolacria, or "bloody tears," as a sign of scleral buckle (SB) infection. This is an interventional case series of three eyes of three patients with hemolacria after SB placement. Two men and one woman were treated for recurrent hemolacria after SB placement for a rhegmatogenous retinal detachment. Two patients had an encircling silicone sponge placed, one 6 years and the other 3 years before presentation. The third patient had a segmental solid silicone element placed 3 months before presentation. Two of the patients reported between 6 to 10 episodes of hemolacria occurring for "years" before referral and diagnosis. In all three patients, hemolacria originated from an occult conjunctival fistula overlying or adjacent to an exposed SB. Microbiological cultures grew Staphylococcus aureus in two eyes and polymicrobial growth in the other. Hemolacria resolved with explantation of the SB in two patients and with long-term continuous topical antibiotics in the other patient. Hemolacria can be a sign of a SB infection and should raise a high level of suspicion for the presence of an occult conjunctival fistula with exposure of the underlying scleral buckling element when frank exposure is not seen.

Scleral buckle for progressive symptomatic retinal detachment complicating retinoschisis versus primary rhegmatogenous retinal detachment

Objective: To compare the functional and anatomic outcomes of encircling scleral buckle placement for the repair of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR) with outer-layer breaks (OLBs) posterior to the equator versus primary rhegmatogenous retinal detachment (RRD). Design: Retrospective comparative case series. Participants: Thirty-seven patients with PSRDCR with OLBs posterior to the equator (group A) and 703 patients with primary RRD (group B). Methods: All eyes were treated with an encircling scleral silicone band (style 240). External drainage of subretinal and retinoschisis cavity fluid and cryopexy or laser photocoagulation around the tears and the OLBs were performed in all eyes. Best-corrected visual acuity at 6 months postoperatively and final retinal reattachment rate were analyzed. Results: There was no statistically significant difference between the 2 groups in terms of patient age, gender, percentage of retinal detachments that were macula-off ( p = 0.241), and preoperative best-corrected Snellen visual acuity ( p = 0.927). Best-corrected Snellen visual acuity at 6 months postoperatively was ≤ 20/100 in 35% of eyes, 20/100–20/50 in 14% of eyes, and ≥ 20/40 in 51% of eyes in group A versus ≤ 20/100 in 37% of eyes, 20/100–20/50 in 33% of eyes, and ≥20/40 in 30% of eyes in group B ( p = 0.12); the final retinal reattachment rate was 97% in group A versus 98% in group B ( p = 0.77). Conclusions: Placement of an encircling scleral buckle may be an effective method to manage both PSRDCR with OLBs posterior to the equator and primary RRDs. The procedure is associated with comparable visual acuity and anatomic outcomes for both types of retinal detachment.

MACULAR HOLE FORMATION AND CLOSURE AFTER CATARACT EXTRACTION AND Nd:YAG CAPSULOTOMY IN A VITRECTOMIZED EYE WITH AN EPIRETINAL MEMBRANE.

Vitreomacular traction and degeneration of the inner retinal layers of the fovea are considered contributing factors to idiopathic macular hole (MH) formation. This case report illustrates a rare scenario of MH formation and spontaneous closure associated with an epiretinal membrane (ERM) and perifoveal cystoid edema without anteroposterior traction from the vitreous in a previously vitrectomized eye. A case report following MH clinical progression with visual acuity and serial optical coherence tomography. A 47-year-old high myope underwent scleral buckle placement and pars plana vitrectomy for a macula-off, phakic, inferior retinal detachment with a giant retinal tear and proliferative vitreoretinopathy 2.5 years ago with eventual visual acuity of 20/20. Postoperatively, an ERM developed, and uncomplicated phacoemulsification cataract extraction was later performed. One week after Nd:YAG capsulotomy, a full-thickness MH formed (with perifoveal cystoid macular edema) that spontaneously resolved 2 months later with return of vision to 20/20. After vitrectomy, anteroposterior vitreofoveal traction no longer contributes to MH formation. Perifoveal cystoid macular edema as well as tangential traction from ERMs may contribute to MH formation.

Risk Factors for Scleral Buckle Removal: A Matched, Case-Control Study

To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal. Retrospective, consecutive, matched, case-control study. Cases included all patients undergoing SB removal between August 1988 and December 2007 at a single academic center. Cases were matched against four randomly selected control patients who underwent SB implantation during the same year as the case. Odds ratios (OR) were calculated for each factor investigated. Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, using univariate analysis, included concurrent globe-penetrating injury at time of SB placement (OR, 24; 95% confidence interval [CI], 2.9 to 200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; 95% CI, 4.9 to 61), diabetes mellitus (DM) (OR, 7.3; 95% CI, 1.8 to 30), prior chronic topical ocular therapy (OR, 4.3; 95% CI, 1.7 to 11), and subsequent ocular procedures (OR, 3.4; 95% CI, 1.5 to 7.5). Factors independently associated with SB removal using multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; 95% CI, 1.7 to 426), concurrent PPV (OR, 11.3; 95% CI, 2.9 to 45), DM (OR, 8.9; 95% CI, 1.3 to 58), and subsequent ocular procedures (OR, 3.9; 95% CI, 1.4 to 11). Factors that did not alter SB removal risk included patient age; gender; and type, size, or location of buckling elements used. Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.