Scleral Buckling Techniques Research Articles

A Modified Suturing Technique to Produce Temporary Scleral Buckling Effect for Noncomplex Rhegmatogenous Retinal Detachment.

To introduce a surgical technique for temporary scleral buckling of noncomplex rhegmatogenous retinal detachment using a combination of nonabsorbable and absorbable sutures that would induce minimal permanent refractive changes. Twenty consecutive patients (20 eyes) with noncomplex rhegmatogenous retinal detachment were prospectively included. Scleral buckling was performed in all eligible subjects, and encircling buckling was added when necessary. The silicone elements were fixed on the sclera with 5-0 nonabsorbable sutures and tightened to form a ridge with 6-0 absorbable sutures. Best-corrected visual acuity, scleral ridge status, axial length, spherical diopter, and cylinder diopter were collected. All patients achieved primary retinal reattachment with significant improvement of best-corrected visual acuity after surgery. Scleral ridge was obvious and in situ at the 1-month follow-up but diminished at the 3-month follow-up. At the 1-month follow-up, axial length increased from 24.78 mm ± 2.14 mm preoperatively to 25.22 mm ± 2.11 mm, and cylinder diopter increased from -1.99 ± 1.03 to -2.95 ± 1.55 (both P < 0.001). At the 3-month follow-up, axial length, spherical diopter, and cylinder diopter decreased significantly compared with the values at the 1-month follow-up (all P < 0.05). No obvious complications were observed during the whole follow-up. Patients who underwent additional encircling buckling exhibited greater changes in axial length and cylinder diopter at the 1-month follow-up (both P < 0.001). The modified technique of scleral buckling with/without encircling buckling using both nonabsorbable and absorbable sutures offers a safe and effective option to repair noncomplex rhegmatogenous retinal detachment, which would offer an adequate temporary scleral buckling effect and induce minimal permanent refractive changes.

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.

MACULAR SLING: A CUSTOMIZABLE METHOD FOR MACULAR BUCKLING USING AVAILABLE ELEMENTS.

Macular buckling surgery is used to treat certain cases of myopic traction maculopathy but is rarely performed in the United States. One of the main factors limiting its use is the lack of commercially available buckling elements. Here, we describe a novel technique for creating an effective macular buckle using readily obtainable buckling materials. By using a traditional circumferential 41 band as the anchoring point around the globe, a 240 band can then be attached and oriented posteriorly along the superonasal-inferotemporal axis. This posterior 240 band is then used to guide a grooved sponge (509G) under the macula to create a customizable and titratable tamponade effect along the posterior pole. This approach was used to provide external support in the case of a recurrent, complex tractional retinal detachment which had failed multiple prior vitrectomy-based repairs. Placement of the macular sling resolved the patient's recurrent retinal detachment with return of the visual acuity to her preoperative baseline. There have been no adverse effects related to the surgery aside from a large hyperopic shift due to the buckle effect on the macula. We believe the technical and material complexity of this technique is comparable with that of more common scleral buckling techniques. This macular sling technique can be used to create an effective posterior buckle without requiring specialized materials.

Minimal Gas Vitrectomy with Scleral Buckle to Minimize Retinal Displacement in Rhegmatogenous Retinal Detachment with Inferior Breaks.

To present a novel technique, minimal gas vitrectomy with scleral buckle (MGV-SB), as a means of potentially minimizing retinal displacement compared to standard vitrectomy or vitrectomy/scleral buckle for select cases. A patient with a right macula off retinal detachment and retinal breaks at 7 o'clock and 10 o'clock underwent a 23-gauge pars plana vitrectomy, localization and cryopexy of the breaks along with an inferior temporal segmental scleral buckle. No air-fluid exchange was performed. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 ml and intravitreal injection of 0.6 mL pure sulfur hexafluoride were then performed. The patient was advised to perform the steamroller maneuver with initial face down positioning for 6 hours. The patient achieved retinal reattachment and post-operative wide-field fundus autofluorescence imaging demonstrated a high integrity retinal attachment (HIRA) with no retinal displacement. The MGV-SB technique has the potential to minimize retinal displacement in cases with inferior break(s) by using a small volume expansile gas tamponade and localized scleral buckle compared to standard vitrectomy or vitrectomy/scleral buckle with a full gas fill.

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.

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

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

A Comparative Analysis of Use of Google Glass versus. GoPro Intraoperative Video Recording of Scleral Buckle Surgery

Abstract Importance The scleral buckle technique is difficult to teach, given a decrease in the frequency of its use and the challenges of its video recording. Background This study compares two different modalities for recording intraoperative videos of scleral buckle surgery. Design Present study is a cross-sectional survey conducted in an academic hospital. Participants A total of 36 medical students, ophthalmologic residents, and vitreoretinal surgery fellows participated in this survey. Methods Five scleral buckle surgeries were filmed simultaneously using Google Glass and GoPro. Single-masked survey of trainees comparing video and audio quality of 38 10-second clips from each device, and listing the steps of scleral buckle surgery. Institutional review board approval and informed consent were obtained. Main Outcome Measures Trainees were asked for grading the video device with respect to audio and video quality as favorable or unfavorable. Results GoPro clips had more favorable ratings of video (73.3%) and audio (75.9%), compared with Google Glass (36.7 and 58.5%, respectively; p &lt; 0.005). A total of 2.8% respondents listed the correct order of surgical steps in pretest, compared with 55.6% in posttest (p &lt; 0.005). Conclusion and Relevance Wearable recording devices can allow for video recording of scleral buckle surgery which has high utility in teaching trainees. GoPro and Google Glass each have distinct advantages.

Регматогенная отслойка сетчатки у детей

Purpose. To study the etiological structure of rhegmatogenous retinal detachment, the efficacy and outcomes of its surgical treatment in pediatric practice. Material and Methods. A retrospective series of cases in one vitreoretinal center in 2015–2019 was presented. The age of the children with rhegmatogenous retinal detachment (57 patients / 66 eyes) was from 0 to 18. Surgical treatment included vitreoretinal and scleral buckling techniques. Results. Rhegmatogenous retinal detachment in 30.3% of cases developed against the background of ROP, in 24.2% – against the background of Stickler‘s syndrome, in 12.1% – against the background of myopia, in 12.1% – against the background of trauma, and in 21.3 % – against the background of other reasons. On average, the anatomical treatment efficacy was 77.4%. The leading factors of an unfavorable outcome of treatment were the duration of presence of retinal detachment (OR 21.44; CI 3.76– 122.16) and 3–5 stages ROP (OR 2.56; CI 0.76–8.44). Visual acuity exceeding the blindness threshold (Vis &gt; 0.02) was maintained or achieved in 72% of cases. Conclusions. The specificity of the clinical course and adherence to surgical treatment of children with rhegmatogenous retinal detachment is determined by its etiology. Key words: retinal detachment in children, Stickler syndrome, retinopathy of prematurity, scleral buckling, vitreoretinal surgery.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

Wide-angle 3D viewing system with valved trocar applied to chandelier-assisted scleral buckling.

Scleral buckling (SB) has been the first technique to repair a retinal detachment (RD) and it is still largely in use. Pars plana vitrectomy (PPV) is currently the most common technique, being more versatile and easier to approach. Here we report on a new SB variant, modified by using some of the latest technological advances borrowed from PPV. We retrospectively reviewed all our SB cases from November 2017 to November 2018, all of them performed with a chandelier, mounted on valved trocar, to provide 3D wide-angle viewing. 107 eyes of 107 patients (mean age of 59 ± 8 years, 61 [57%] males) underwent primary uncomplicated RD surgery using this modified SB technique and were enrolled for this study. In this article, the technique is thoroughly described with an online video presentation. Briefly, thanks to valved trocar insertion, it combines the latest breakthroughs in the field of PPV viewing systems with traditional SB surgery. Our first-year data reveal a primary success rate of 94% (101 cases out of 107) at 3 months follow-up. A hidden retinal lesion, undetected at clinical pre-operative evaluation, was found intraoperatively in 12 (8.9%) cases. The use of a digital three-dimensional (3D) visualization system, coupled with the positioning of a single 25 gauge valved trocar with chandelier, dramatically simplifies the traditional SB and flattens its learning curve, making this procedure more accessible to young surgeons. In addition, the better visualization capability yields to higher possibility to detect and treat all retinal lesions.

Scleral Buckling Using Chandelier and Releasable Suture: A Useful Surgical Variant.

To describe a surgical variant for scleral buckling technique using a chandelier and scleral releasable suture. We collected retrospectively 20 eyes of 20 patients who underwent to scleral buckling for retinal detachment. In all cases, the surgeons performed the surgical variant of scleral buckling using a 27-gauge (G) chandelier as endoillumination and releasable 7.0 vicryl scleral suture. None of the operated eyes developed lens opacity or lens marks at the entrance site of the chandelier used during the surgery, and no cataract development was observed as well, during the follow-up. Retinal reattachment was achieved in 19 out of 20 eyes at the first surgery in the follow-up time of 6 months. The association of chandelier and releasable suture was a useful surgical variant when performing scleral buckling technique for retinal detachment. Complications like lens opacity or lens marks at the entrance site of the chandelier due to the use of chandelier itself can be greatly reduced, as well as complications due to vitreous prolapse from the sclerotomy by using releasable scleral suture.

Combined Surgery in Rhegmatogenous Retinal Detachment (Scleral Buckle Vitrectomy): Indications and Applications

Supplemental scleral buckling techniques in vitrectomy for the repair of rhegmatogenous retinal detachment to achieve higher reattachment rates are not widely used but may be useful especially in complicated cases. In this article, the positive and negative aspects of adding scleral buckle to primary vitrectomy will be examined by looking at relevant studies.

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.

Modified Hamilton’s Controlled Encircling Procedure for Retinal Detachment

Purpose: To describe a novel, simple, and reproducible encircling scleral buckle technique based on Hamilton’s controlled encircling procedure in order to standardize buckle height achievement in cases of retinal detachment. Methods: We describe a case series in which a novel modification of Hamilton’s surgical technique was used, consisting of a typical encircling buckling procedure anchored in the center of each quadrant, with the ends of the band passed through a Watzke sleeve. Reference marks were placed to allow measurable shortening of the band when its ends were pulled to create an encircling indent. Postoperative ultrawide field retinal images were analyzed. Results: Our simple technique yielded predictable and reproducible postoperative scleral buckle heights. Shortening of the silicon band by 3, 4, 5, and 6.25 mm produced shallow indents, while additional shortening was considered excessive. Conclusion: Published studies about scleral buckle as a primary procedure or a combined technique with vitrectomy lack a uniform surgical technique. Our modification of Hamilton’s technique uses objective measurements to generate a consistent and predictable postoperative buckle height.

Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery

To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques. Population-based, retrospective cohort study. All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n= 537). International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed. Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA). Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P= 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P= 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery. In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.

SCLERAL BUCKLE SURGERY FOR PRIMARY RETINAL DETACHMENT WITHOUT POSTERIOR VITREOUS DETACHMENT.

To present and analyze the anatomical and functional outcomes for scleral buckling (SB) in a group of patients with rhegmatogenous retinal detachment without posterior vitreous detachment. A total of 244 patients underwent SB from 2005 through 2014 by a single surgeon (A.W.E.). Forty patients (45 eyes) were identified as fulfilling the criteria of presenting with a rhegmatogenous retinal detachment without posterior vitreous detachment. Visual outcomes, preoperative retinal findings, and the SB technique were analyzed. The main outcome measure was the primary reattachment rate at 6 months after single surgery. The mean age was 29 years (range 11-51 years). The mean follow-up period was 20 months. The mean refractive error was -5.16 diopters. Subretinal fluid drainage was performed in 17 eyes (37.8%). The anatomical success rate after single SB surgery at 6 months was 91.1%. The only factor that had statistically significant correlation with primary anatomical failure was development of subretinal hemorrhage during the drainage procedure (P = 0.03). Despite an increasing trend toward primary vitrectomy for rhegmatogenous retinal detachment, an indication for SB is in younger patients without a preexisting posterior vitreous detachment. We showed a 91.1% success rate with a primary SB and 100% with a second surgery.

29G chandelier‐assisted scleral buckling with new instruments

SummaryPurposeTo modify a scleral buckling technique for retinal detachment (RD) treatment using 29‐gauge twin‐light chandelier, non‐contact viewing system and a new illuminated indenter‐marker.MethodsEight consecutive patients (8 eyes) were enrolled to this prospective observational study. During every surgery a new illuminated indenter‐marker was used. Standard ophthalmologic examinations were performed before and after the surgery. The evaluation of the surgery duration was performed in every case.ResultsThe mean initial best corrected visual acuity (BCVA) was 20/200, and after the surgery – 20/80. The retina reattached in all cases. The mean time of the surgical procedure was 35.12 min ± 9.05 min. In all cases minimal segmental buckle were used. In two cases an additional suturing of the sclerotomy after endolight withdrawal was necessary.ConclusionEndoillumination‐assisted scleral buckling is a novel approach for RD treatment, which can be performed using microscope and non‐contact viewing system. The new illuminated indenter‐marker facilitates easier, and more controlled localisation of the retinal breaks with simultaneous marking of the desired area.

Long-term risk of glaucoma after encircling scleral buckle.

To determine the long-term risk of developing glaucoma after an encircling scleral buckle procedure. Retrospective case series of patients with at least 10 years of follow-up who underwent successful, unilateral retinal detachment repair by encircling scleral buckle. The main outcome measure was the proportion of eyes that developed perimetric glaucoma of buckled compared with fellow eyes. Sixty-eight patients with an average postoperative follow-up of 21 years were included. Perimetric glaucoma developed in 13% (9 patients), and an additional 22% (15 patients) had preperimetric glaucoma or were glaucoma suspects. Perimetric glaucoma was present in 2.9% of patients in the buckled eye only, 8.8% in the fellow eye only (P = 0.27), and 1.3% in both eyes. There was no increased prevalence of ocular antihypertensive use in buckled (5.9%) compared with fellow eyes (11.8%, P = 0.36). Our study showed no evidence of increased risk for developing glaucoma after repair of retinal detachment in eyes that underwent an encircling scleral buckling technique compared with fellow eyes with follow-up of at least 10 years.

Complications of Encircling Bands-Prevention and Management

Encircling bands are a simple and efficient technique of scleral buckling, commonly used alone, in conjunction with segmental scleral buckles, and in conjunction with trans pars plana vitrectomy (TPPV) to treat rhegmatogenous retinal detachment (RRD) by closing retinal breaks and relieve vitreoretinal traction. Complications associated with encircling bands are relatively rare, but can include severe and occasionally intractable “band pain”, infection, myopia, band intrusion and extrusion, ocular motility disturbances, anterior segment necrosis, and ocular perforation. The indications and rationale for encircling bands and guidelines to minimize and treat complications are discussed.