Scleral Buckling Techniques Research Articles

Outcome of surgery for rhegmatogenous retinal detachment in a Nigerian Eye Hospital

To determine the treatment outcome of rhegmatogenous retinal detachment at the Guinness Eye Centre Onitsha, Nigeria. Case files of patients who had surgery for rhegmatogenous retinal detachment at the Guinness Eye Center Onitsha between June 1997 and May 2012 were reviewed. Information obtained included age, sex, presenting and post-operative visual acuity, anatomical reattachment, post- operative complications and causes of treatment failure. Fifty four patients, 33 males and 21 females, age range: 48-79 years, median-56 years, had surgery. Three patients had giant retinal tears; 10 patients also had proliferative vitreo-retinopathy(PVR). Symptoms duration was 7 days to 18 months; median-7 months; the post-surgery follow-up was 9 months to 6 years; median -2 years.While 47(87%) patients had pre-operative visual acuity<3/60 in the affected eye, post-operatively 48(88.9%) patients achieved acuity e" 3/60, with 14(25.9%) attaining uncorrected visual acuity of 6/9 - 6/18. The retina remained attached 6 months after surgery in 45(83.3%) patients.The post- operative complications included re-detachment, 12(22.2%) patients, cataract, 5(9.3%), exposed explant, 2(3.7%), suture granuloma, diplopia and retinal haemorrhage, 1(1.9%) patient each.The surgical failure in the 12 patients were were due to PVR (9 patients) and missed retinal holes (3 patients). Despite poor infrastructure and late presentation by patients, the anatomical and visual results of surgical treatment of rhegmatogenous retinal detachment using cryo-retinopexy and scleral buckling technique are encouraging. Better results would be expected if patients presented early and facilities for vitrectomy provided for tackling complex detachments.

Modified Scleral Buckling Technique Using Endoillumination and Non Contact Wide Angle Viewing System

Purpose: To assess feasibility and surgical outcome of a new scleral buckling technique for rhegmatogenous retinal detachment using endo illumination and noncontact wide angle viewing system.Material and Methods: Eleven eyes of 11 patients underwent modified scleral buckling for rhegmatogenous retinal detachment. A custom modified 23 G endo illuminator and noncontact wide angle viewing system was utilized instead of binocular indirect ophthalmoscope to visualize fundus intra operatively.Results: The mean age of patients was 45.3 years. Out of 11 patients, 9 patients (82%) achieved retinal reattachment while 2 patients had to undergo pars plana vitrectomy with silicone oil tamponade due to development of proliferative vitreoretinopathy. 8 (72%) patients achieved stabilization / improvement in visual acuity. 2 patients had minimal subretinal hemorrhage at the time of subretinal fluid drainage.Conclusion: Combining wide angle viewing system and microsurgery with scleral buckling provides a useful and safe alternative for viewing fundus during retinal reattachment surgery.

Traumaassoziierte rhegmatogene Netzhautablösung im Kindesalter

Rhegmatogenous retinal detachments (RRD) in children and adolescents are uncommon and present about 3-5 % of all retinal detachments. Etiology, pathogenesis and therapy differ significantly from adults. The current study addresses juvenile RRD after trauma to contribute to the limited knowledge about this condition. The current study includes 27 eyes of 25 patients aged up to 18 years that were operated on between 2000 and 2012. They presented 42.4 % of all RRD of that age group. We analyzed the following parameters: demographic data, retinal detachment characteristics, surgical techniques and outcomes. Mean age was 15,3 years and 77 % were boys. Retinal detachment occurred between 3 days and 11 years after trauma (median: 3,5 months). Two thirds of RRDs were classified as acute, the remainder showed symptoms of chronicity, e.g. pigment demarcation and subretinal strands or PVR. The macula was detached in 81,5 %. Retinal dialysis was the most common type of break (44,8), followed by giant retinal tears (18,5 %). In 3 out of 5 eyes with severe PVR due to self-aggressive behavior a causative retinal defect was not identified. Episcleral buckling surgery was the preferred method in any case that deemed manageable with a segmental sponge or encircling band (14 eyes). Primary vitrectomy was performed in more complex retinal detachments (13 eyes), and most of them had silicone oil tamponade. Primary reattachment was achieved in 83 % in the buckling group and 80 % in the vitrectomy group (3 eyes with self-harm excluded). Finally, all eyes had attached retinas. Postoperatively, visual acuity improved or remained stable in successfully treated eyes. Late complications in the vitrectomy group were cataract development in half of the phakic eyes. Retinal dialysis and giant retinal tears are the most frequent retinal lesions in posttraumatic RRD. Delayed diagnosis is a common problem, as most of the cases preset with macula-off detachments and clinical signs of chronic RRD. A conventional approach to traumatic RRD using scleral buckling techniques is recommended whenever possible. Differently from adults, strong vitreoretinal adhesions are present and the vitreous is rarely detached which makes a complete vitrectomy challenging. Furthermore there is a significant risk of postoperative cataract despite of the young age. However, cases with giant retinal tear and complex detachments due to PVR require vitrectomy maneuvers, usually with the use of silicone oil. A special subgroup presents PVR-detachments due to chronic auto-aggressive behavior of disabled young patients. Despite of extreme vitreoretinal maneuvers used, those eyes might be inoperable or late failures due to chronic aggressive PVR. On the whole, delayed diagnosis and advanced RRD limit final vision. However, after successful surgery, approximately half of the eyes improve, many retain vision. As preserving vision in young patients is of great impact for their whole lifespan, any attempt should be made to achieve a stable retinal situation.

Pars Plana Vitrectomy alone vs Vitrectomy with scleral buckling for PRDs

AbstractPseudophacik Retinal Detachment is a subgroup of Rhegmatogenous Retinal Retachments with some unique characteristics, such as the number and location of retinal breaks, certain intraoperative technical difficulties and possibly an increased risk of proliferative vitreoretinopathy. Recent evidence has established the role of pars plana vitrectomy as a primary method of managing these cases. The role of using scleral buckling techniques in combination with vitrectomy as well as the types of buckling that could be used remains controversial. At this talk, the above issues will be discussed in full, and a review of the literature as well as the personal experience of the speaker will attempt to clarify the role of using combined techniques in managing those cases.

Amniotic membrane as single treatment in complication of exposed scleral buckle.

To report a case of complicated exposed scleral buckle in which amniotic membrane was used to repair the extremely thin sclera that showed the underlying choroid. Interventional case report. A 65-year-old man presented to our Department with severe eye pain after retinal detachment repair with scleral buckling technique 7 years ago. Examination of the left eye revealed extrusion of the buckle with conjunctival and scleral erosion that allowed distinguishing the choroid. The buckle was removed and successful scleral repair was achieved through the use of amniotic membrane. Amniotic membrane graft is a safe and useful scleral substitute that should be considered to cover scleral defects, in the absence of infection.

A Narrow Silicone Sponge to Close a Wider Retinal Tear: The Open-Book Technique of Scleral Buckling

The authors describe a modified technique for scleral buckling by which a wide retinal tear can be closed with a relatively narrow buckle. An incomplete cut on the silicone sponge can be made so that the halves are connected to each other by a narrow strip of material and opened like a book when buckling. Using this open-book technique, silicone sponges can be used to close horseshoe-shaped retinal tears of one to two times the width of available silicone sponges. This technique was used in four eyes with excellent anatomical results, and no complications could be attributed to the surgical technique. This technique provides an alternative treatment strategy for retinal detachment with relatively wide retinal tears.

Langzeitresultate nach mikrochirurgischer skleraeindellender Ablatiochirurgie

The purpose of this study is to report the long-term results of a refined scleral buckling technique for the treatment of retinal detachments. We retrospectively reviewed the charts of 152 consecutive cases (129 patients), operated in our clinic by one surgeon. Indirect ophthalmoscopy was used for the identification and treatment of retinal breaks. All other steps of the operation were performed under the operating microscope. The main outcome measures were the retinal redetachment rate, intraoperative and postoperative complication rates as well as the functional outcome. Reattachment was achieved in 130 eyes (85.5 %) after the first procedure and in 151 eyes (99.3 %) after reoperation. No intraoperative complications occurred in our series. Eighty-one eyes (53.3 %) showed a significant improvement in visual acuity after surgery, whereas 16 eyes (10.5 %) showed a significant deterioration in visual acuity. At the last follow-up visit, 101 cases (66.4 %) showed a visual acuity of 0.5 or better, 68 cases (44.7 %) had a visual acuity of 0.8 or better and in 7 cases (4.6 %) the visual acuity was lower than 0.1. Adding microsurgical techniques to scleral buckle surgery may help to minimise the incidence of intraoperative and postoperative complications resulting in a favourable functional outcome.

Primäre 25- und 23-Gauge-Vitrektomie in der Behandlung der rhegmatogenen Netzhautablösung – sinnvolle Ergänzung oder Schritt in die falsche Richtung?

Pars plana vitrectomy techniques with 25- and 23-gauge transconjunctival systems are rapidly growing in popularity. These systems were mainly used in the treatment of macular diseases. However, an expansion to more complicated vitreoretinal procedures including the treatment of rhegmatogenous retinal detachments can currently be observed. In this review, the results and complications of 25- and 23-gauge vitrectomy techniques are analysed. A review has been made of the current literature concerning 25- and 23-gauge vitrectomy techniques with particular attention to the treatment of rhegmatogenous retinal detachments. The benefits of 25-gauge and 23-gauge vitrectomy (shorter operating times, decreased inflammation of the anterior segment, increased patient comfort and enhanced visual recovery) are of no clinical significance when treating rhegmatogenous retinal detachments and do not seem to offer an advantage over 20-gauge vitrectomy or scleral buckling techniques. Recently published series with primary anatomic reattachment rates between 71% and 93% and a mean postoperative visual acuity of 20/50 seem to suggest a worsening of the treatment results with these new techniques. In addition, 25-gauge and 23-gauge techniques are technically challenging, associated with significant complications (for example, postoperative hypotony) and increase the risk for exogenous endophthalmitis. New 25-gauge and 23-gauge vitrectomy techniques for rhegmatogenous retinal detachment show no advantage over scleral buckling techniques in phakic patients or 20-gauge vitrectomy in pseudophakic patients. Moreover, these techniques seem to worsen the outcome and increase the postoperative complication rate.

SUPER VISCOUS SILICONE LIQUID IN RETINAL SURGERY

Very high viscosity (12500 centistokes) liquid silicone was injected into the vitreous of 47 eyes of 46 patients with complicated retinal detachment over a two year period. Only eyes judged inoperable by scleral buckling and/or vitrectomy techniques were considered. Complete anatomical reattachment was achieved in 34 cases (72%) while partial reattachment was achieved in a further six cases (13%). All eyes in which complete or partial retinal reattachment was achieved showed improvement in vision but this was usually restricted to count fingers or 6/60 at 3 months to 2 years follow-up. Mounting evidence now suggests that previous clinical opinions claiming an unacceptable toxicity rate with liquid silicone may be misleading.

Anatomical retinal reattachment after scleral buckling with and without retinopexy: a pilot study

To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s). In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34-48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35-56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically. With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.

Recent Trends in the Management of Rhegmatogenous Retinal Detachment

It has been nearly a century since Jules Gonin performed the first intervention for rhegmatogenous retinal detachment, trans-scleral cautery, achieving successful outcomes in close to 50% of his cases. With the introduction of alternative surgical approaches in the last half-century, including Charles Schepens' scleral buckle technique and Robert Machemer's pars plana vitrectomy, the surgical success rates have risen to close to 90%. Nonetheless, despite dramatic progress in the success of reattachment surgeries, reasonable disagreement exists as to which approach (or combination of approaches) is the best form of surgical intervention for patients with rhegmatogenous retinal detachments. In this review, the authors summarize the current knowledge of retinal detachment, and examine emerging results from the first large scale, prospective, randomized, controlled clinical trials addressing the efficacy of these surgical approaches for retinal detachment, with the hope of identifying the most appropriate (evidence-based) therapeutic intervention for the treatment of rhegmatogenous retinal detachment.

Descolamento regmatogênico de retina: avaliação pós-operatória da mácula

To evaluate the structure and function of the macula following rhegmatogenous retinal detachment surgery. Prospective study of patients submitted to scleral buckle surgery or pneumatic retinopexy. The follow-up comprised a complete ophthalmologic exam and optical coherence tomography. The sample was composed of 14 eyes (14 patients), 71.4% operated with the scleral buckle technique, and 28.6% with the pneumatic retinopexy. The age range was from 24 to 59 years (mean of 39.3 years). There was a negative correlation between the final visual acuity and age of patient (r=-0.64, p=0.0127) and between final vision and duration of detachment (r=-0.54, p=0.0447). There was a positive correlation between visual acuity at initial follow-up and that at the final follow-up (r=0.69, p=0.0059). The optical coherence tomography of the initial follow-up showed subclinical foveal detachment in four eyes (28.6% of cases); at the final follow-up the retina was applied by itself with improved vision in all eyes (p=0.031), regardless the time span until reapplication (p=0.5546). The results show that the younger the patient and the earlier the surgical procedure, the better the final visual acuity. Furthermore, there is a positive correlation between initial and final postoperative vision and, all cases that presented foveal detachment on the optical coherence tomography at the initial follow-up had the retina flattened and the vision improved at the final examination.

The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments

Purpose To present a current series that determined the effect of duration of macular detachment (DMD) and patient age on postscleral buckle (SB) visual acuity (VA) and anatomic results. Design Retrospective, noncomparative, observational case series. Participants Ninety-four consecutive patients (94 eyes) with primary, uncomplicated, macula-off retinal detachments, a preoperative VA of 20/200 or worse, and a precise history of when macular function was lost. Intervention Standard explant scleral buckle technique performed by multiple surgeons. Main outcome measures Visual acuity, anatomic reattachment, and proliferative vitreoretinopathy. Results Visual acuity after SB of 20/40 or better was seen in 71% of eyes with a DMD of 10 days or fewer, 27% of eyes with a DMD of 11 days to 6 weeks, and 14% of eyes with a DMD of more than 6 weeks. Eyes achieved a mean VA after SB of 20/41 after a DMD of 10 days or fewer, 20/121 after a DMD of 11 days to 6 weeks, and 20/178 after a DMD of more than 6 weeks. No decrease in VA was seen within the 1- to 10-day period or the 11 days to 6 week period of DMD. Patients 60 years of age or less achieved a mean VA after SB of 20/47 compared with 20/81 for patients between 61 to 75 years of age and 20 of 96 in patients more than 76 years of age. Duration of macular detachment and patient age had no statistically significant effect on final anatomic reattachment after SB, reoperation rate, or proliferative vitreoretinopathy. Conclusions Eyes with primary, uncomplicated, macula-off retinal detachment repaired with SB achieve excellent postoperative VA if repaired within the first 10 days of macular detachment. These results are better than the VA in eyes repaired after 11 days to 6 weeks and more than 6 weeks of macular detachment. Patients 60 years of age and younger obtained better postoperative VA than older patients. Duration of macular detachment and patient age did not significantly effect anatomic outcomes.

Phacoemulsification and lens implantation after scleral buckling surgery

PURPOSE: To determine the intraoperative and postoperative complications and best-corrected visual acuity outcomes of eyes undergoing phacoemulsification and intraocular lens implantation after retinal detachment repair by the scleral buckling technique. METHODS: The charts of all patients who underwent phacoemulsification and intraocular lens implantation between July 1991 and May 1998 in two surgical practices were reviewed to identify eyes with a history of retinal detachment repaired by the scleral buckling technique. Eyes with a history of pars plana vitrectomy were excluded. Demographic and surgical data, preoperative and postoperative best-corrected visual acuity, and intraoperative and postoperative complications were recorded. RESULTS: We identified 34 eyes of 32 patients. The mean interval from retinal detachment repair to phacoemulsification was 12.4 years. The mean interval from phacoemulsification to final examination was 20 months. Risk factors for retinal detachment included isolated myopia (82%), myopia with lattice retinal degeneration (5.9%), and myopia with trauma (8.8%). One eye (2.9%) had no identifiable risk factors. Final best-corrected visual acuity of 20/40 or better was attained in 29 (85%) of 34 eyes and 20/20 or better in 18 (53%) of the eyes. Of the five eyes with the lowest best-corrected visual acuity, three had a macula-off retinal detachment; one had a posterior capsule opacity, epiretinal membrane, and corneal edema secondary to ocular ischemia; and one had advanced glaucoma. All five eyes still experienced an improvement in best-corrected visual acuity. With regard to complications, one eye had a posterior capsular tear with vitreous loss and another developed a postoperative retinal tear. Posterior capsule opacification requiring laser capsulotomy developed in 13 eyes (38%). No eye developed a retinal redetachment. CONCLUSION: Phacoemulsification and intraocular lens implantation can be performed safely after scleral buckling surgery and excellent best-corrected visual acuity results can be attained in most eyes. No modification of surgical technique is necessary. No retinal redetachment occurred in this series.

Pneumatic Retinopexy and Buckling

To the Editor. —We read with interest the article by Smiddy et al, in the October 1989 issue of theArchives. We agree with the authors that an encircling element frequently results in increased axial length and induced myopia and that a radial buckle infrequently results in significant postoperative refractive change. We take exception to their concluding comment, which stated that this study was not designed to compare pneumatic retinopexy with scleral buckling, but candidates for pneumatic retinopexy can usually be treated with a radial scleral buckle. We would like to point out that several studies have shown pneumatic retinopexy to be effective for complicated retinal detachments involving multiple breaks in multiple quadrants and large tears exceeding 30°. 2,3 These cases, if treated with scleral buckling techniques, usually require an encircling element. The Pneumatic Clinical Trial 4 addressed retinal detachments secondary to a break(s) within 30°. Although these cases could

Retina

The neurosensory retina is the only portion of the central nervous system exposed to the light of the outside world. Despite previous advances, many mysteries remain regarding the function and dysfunction of this vital tissue. This is underscored by the morbidity retinal diseases carry in the United States, with diabetic retinopathy and age-related macular degeneration ranking as the two leading causes of irreversible legal blindness in the United States.¹ In comparison with the medical sciences as a whole, the history of vitreoretinal ophthalmology is short and kinetic, with many of the field's innovators still alive and practicing. In the United States the beginnings of the subspecialty were with Charles Schepens, who popularized external scleral buckling techniques as the first modern treatment for retinal detachment in the 1940s and 1950s. Further advances followed in the 1950s and 1960s with the origination of fluorescein angiography by Novotny and Alvis, Meyer-Schwickerath's description

Pneumatic Repair of Primary and Secondary Retinal Detachments Using a Binocular Indirect Ophthalmoscope Laser Delivery System

Using intravitreal gas injection of sulfur hexafluoride after retinopexy utilizing a binocular indirect ophthalmoscope argon laser delivery system, the authors treated 12 primary rhegmatogenous retinal detachments and 10 detachments which recurred after previous scleral buckle surgery. Topical anesthesia only was used in most of the cases (18 of 22). Detachments in all quadrants of the fundus were repaired. Twenty cases remained successfully attached after a minimum follow-up of 6 months. Two failures occurred early in eyes with primary retinal detachments and both were successfully repaired by conventional scleral buckling techniques. The authors found pneumatic retinal reattachment in conjunction with laser retinopexy to be particularly valuable in repairing secondary detachments, thereby avoiding conventional surgical reoperations.

The Lincoff Temporary Balloon Buckle

The Lincoff temporary balloon buckle is an equally effective alternative to more conventional techniques in the management of selected retinal detachments. We used this technique in the management of 45 selected primary retinal detachments operated on since Nov. 22, 1980. Initial complete retinal flattening was achieved in 42 eyes (93%). Two of the three eyes that initially did not show complete flattening ultimately went on to do well without further surgery. Redetachment occurred in three of the five aphakic eyes (60%) and in four of the 36 phakic eyes (11%). None of the retinas in the four eyes with intraocular lenses redetached. Conventional scleral buckling techniques were used in the one case of initial failure and in the seven cases of redetachment for a final success rate of 98% after an average follow-up of 13 months.

Scleral buckling methods for rhegmatogenous retinal detachment.

Scleral buckling techniques are effective in treating most eyes with rhegmatogenous retinal detachment, and usually the final visual result is limited only by possible preexisting macular damage due to the detachment. Still, a variety of techniques are used, including exoplant or implant methods for the scleral buckle; cryotherapy, diathermy, or photocoagulation to cause the chorioretinal adhesion; and drainage or nondrainage of subretinal fluid. Also, recent development of alternative surgical techniques such as vitreous surgery and/or intraocular gas injection have raised questions about the current role of scleral buckling methods. This article reviews the principles and techniques of scleral buckling for retinal detachment and describes the methods we have found most useful.

Management of Retinopathy of Prematurity

Seventeen patients with symmetrical stage 3 retinopathy of prematurity (ROP) and plus disease as described in the International Classification of ROP had one eye randomized to cryotherapy and the other to control. Seventy-seven percent of the patients were under 1000 grams at birth and females outnumbered males by a 2 to 1 ratio. The average chronologic age at which cryotherapy was performed was three months. Twelve of seventeen treated eyes (71%) showed resolution of the ROP and 10 of 17 untreated eyes (59%) became significantly worse. However, only five patients had improvement in the treated eye and progression in the untreated eye, a number too small to provide statistical significance. Six eyes with Stage IV ROP were operated by encircling scleral buckling techniques because of total retinal detachment secondary to peripheral traction and cicatrization arising from the ridge. In five patients the unoperated eye had already developed a retrolental membrane, and in one patient bilateral detachments were present. Five of the six operated retinas were reattached.