Scleral Buckling Research Articles

Epiretinal Membrane Formation following Rhegmatogenous Retinal Detachment Repair: A Retrospective Cohort Study

Introduction: This study aimed to investigate the incidence of and risk factors for epiretinal membrane (ERM) formation following primary rhegmatogenous retinal detachment (RRD) repair. Methods: This comparative, retrospective, single-center cohort study included eyes with primary RRD treated between 2011 and 2023 at Massachusetts Eye and Ear, Boston, Massachusetts, with pars plana vitrectomy (PPV), scleral buckle (SB), PPV+SB, or pneumatic retinopexy (PnR). Demographic, clinical, and surgical parameters were collected from medical records. The primary outcome was the risk of ERM formation, while the secondary outcome was the risk of ERM requiring surgery. Univariable and multivariable Cox regression were performed, and a hazard ratio (HR) and 95% confidence interval (95% CI) were reported. Results: Overall, 394 eyes were included. The mean age was 58.49 ± 12.8 years, and most patients were male. There was a significantly lower risk of ERM formation following SB compared to PPV in the univariable analysis (HR = 0.2, 95% CI = 0.08–0.60, p = 0.003); however, there was no significant association between treatment modality and ERM formation on multivariable Cox regression controlling for confounding factors (p = 0.24). ERM formation was found more commonly in patients who were older (HR = 1.0 per 1 year increase in age, 95% CI = 1.01–1.04, p = 0.001), those with worse baseline visual acuity (HR = 1.3, 95% CI = 1.09–1.71, p = 0.008), and those with macula-off RRDs (HR = 2.1, 95% CI = 1.41–3.32, p < 0.001). Conclusion: Surgical modality does not have a significant impact on the risk of ERM following retinal detachment repair. However, age, baseline visual acuity, and macular status are important predictors of ERM formation after RRD repair.

Long-term Outcomes of Surgeries for Retinal Detachment Secondary to Parasitic or Viral Infectious Retinitis.

This study sought to compare the long-term outcomes of surgeries for retinal detachment (RD) secondary to viral or parasitic infectious retinitis. A total of 47 eyes that received pars plana vitrectomy with or without scleral buckling due to RD secondary to polymerase chain reaction-proven viral (cytomegalovirus, varicella zoster virus, and herpes zoster virus) or parasitic (toxoplasma and toxocara) retinitis from October 1, 2006, to June 30, 2023, in a single medical center were retrospectively enrolled. Mean follow-up period was 59.03 ± 55.24 months in viral retinitis and 34.80 ± 33.78 months in parasitic retinitis after primary reattachment surgery. During follow-up, nine eyes (24.3%) with viral retinitis and five eyes (50.0%) with parasitic retinitis developed retinal redetachment. Visual acuity success at final follow-up was achieved in 19 eyes (51.4%) with viral retinitis and six eyes (60.0%) with parasitic retinitis (p = 0.64). The incidence of retinal redetachment during the 1st postoperative year was significantly higher in parasitic retinitis compared with viral retinitis (crude incidence, 0.21 vs. 0.85; p = 0.02). Hazard ratio analysis adjusted for age and sex showed 4.58-fold (95% confidence interval, 1.22-17.27; p = 0.03) increased risk of retinal redetachment in parasitic retinitis compared with viral retinitis during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis. Compared with RD secondary to viral retinitis, RD secondary to parasitic retinitis showed higher incidence of retinal redetachment during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis.

Academic versus Community Retinal Surgery for Primary Retinal Detachment: Characteristics, Duration, and Value Analysis of Teaching Modifier

To compare operative time and case characteristics of primary rhegmatogenous retinal detachment (RRD) repairs between academic and community vitreoretinal surgeons. A retrospective, observational clinical study. Patients who underwent primary RRD repair surgeries at Massachusetts Eye and Ear between 2019 and2021. A random sample of 20 vitreoretinal surgeons distributed evenly among the academic or community setting was selected. Fifteen consecutive cases of primary RRD repair surgeries were included from each surgeon. A cost analysis was performed for the teaching modifier for the physician fee and for hospital costs. Length of surgery. Of 300 primary RRD repairs, fellows were present in 75%, which comprised all academic surgeon cases and 50% of community surgeon cases, P < 0.001. Mean operation length was shorter for community surgeon cases without fellows (55.0 ± 24.1) than either academic (73.0 ± 30.8) or community surgeon cases with fellows (75.7 ± 32.5) (P < 0.001). There was a higher percentage of macula-off RRDs in academic versus community surgeon cases (52.7% vs. 38.0%, P= 0.002) and higher rates of combined scleral buckle (SB)/pars plana vitrectomy (PPV) repairs (14% vs. 3%, P < 0.001). When excluding combined SB/PPV cases, there was no difference in operative time between academic and community surgeon cases. Among RRDs repaired by PPV only, there was a 31.4% (16.6 minutes) greater procedure duration in cases with fellows compared with cases without fellows (P < 0.001). Covariates associated with greater surgery time: addition of an SB (β= 32.6), membrane peel (β= 18.5), presence of a fellow (β= 14.5), proliferative vitreoretinopathy (β= 12.8), and greater number of retinal breaks (β= 2.4). The teaching modifier adds 16% extra reimbursement ($184.16) to the physician fee, which is 50.9% of what is necessary to cover the percentage increase in surgeon time (31.4%). Using a time-driven activity-based costing for hospital costs, the extra 16.6 minutes leads to an additional $1038.00, which is 5.6 times more than the reimbursement for the modifier. Retinal detachment repair cases performed by academic surgeons are more likely to be macula-off and include the addition of an SB, which drive longer operative times. Medicare's reimbursement of the assistant modifier in a teaching facility significantly undercompensates the time-driven activity-based costing of trainee participation. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Outcome of Glaucoma Management in Sturge-Weber Syndrome: Case Series

Objective: To report the clinical findings and outcome of treatment for developmental glaucoma from Sturge-Weber syndrome in four consecutive children managed at a child eye health tertiary facility in Ibadan, Nigeria. Methods: A retrospective case series of four children with Sturge-Weber syndrome (SWS) and developmental glaucoma who underwent surgical treatment for glaucoma over a 3-year period. Information on patients’ sociodemographic data, clinical features, and management are described. Results: Four male children, aged between 7 weeks and 11 years, with unilateral developmental glaucoma and varying extent of port-wine stain were included in the study. The primary surgery in three patients was trabeculectomy, while the fourth patient received a glaucoma drainage device. Shallow anterior chamber, choroidal effusion, and cataract were complications of glaucoma surgery observed. Secondary surgeries performed include anterior chamber reformation, suturing of leaking peritubular scleral channel, sclerotomy and fluid drainage, bleb needling, cataract surgery, and scleral buckle surgery. At the 1-year follow-up visit, one eye had complete success, one eye had qualified success, while the other two had treatment failure. Conclusion: The outcome of management of glaucoma associated with Sturge-Weber syndrome is modest. Though rare, SWS can cause significant ocular and systemic morbidity. Complications of therapy may be encountered, and multiple surgical interventions may be required for optimal management.

Deep Learning for prediction of late recurrence of retinal detachment using preoperative and postoperative ultra-wide field imaging.

To elaborate a deep learning (DL) model for automatic prediction of late recurrence (LR) of rhegmatogenous retinal detachment (RRD) using pseudocolor and fundus autofluorescence (AF) ultra-wide field (UWF) images obtained preoperatively and postoperatively. We retrospectively included patients >18 years who underwent either scleral buckling (SB) or pars plana vitrectomy (PPV) for primary or recurrent RRD with a post-operative follow-up >2 years. Records of RRD recurrence between 6 weeks and 2 years after surgery served as a ground truth for the training of the deep learning (DL) models. Four separate DL models were trained to predict LR within the 2 postoperative years (binary outputs) using, respectively, UWF preoperative and postoperative pseudocolor images and UWF preoperative and postoperative AF images. A total of 412 eyes were included in the study (332 eyes treated with PPV and 80 eyes with SB). The mean follow-up was 4.0 ± 2.1 years. The DL models based on preoperative and postoperative pseudocolor UWF imaging predicted recurrence with 85.6% (sensitivity 86.7%, specificity 85.4%) and 90.2% accuracy (sensitivity 87.0%, specificity 90.8%) in PPV-treated eyes, and 87.0% (sensitivity 86.7%, specificity 87.0%) and 91.1% (sensitivity 88.2%, specificity 91.9%) in SB-treated eyes, respectively. The DL models using preoperative and postoperative AF-UWF imaging predicted recurrence with 87.6% (sensitivity 84.0% and specificity 88.3%) and 91.0% (sensitivity 88.9%, specificity 91.5%) accuracy in PPV eyes, and 86.5% (sensitivity 87.5%; specificity 86.2%) and 90.6% (sensitivity 90.0%, specificity 90.7%) in SB eyes, respectively. Among the risk factors detected with visualisation methods, potential novel ones were extensive laser retinopexy and asymmetric staphyloma. DL can accurately predict the LR of RRD based on UWF images (especially postoperative ones), which can help refine follow-up strategies. Saliency maps might provide further insight into the dynamics of RRD recurrence.

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.

Optimizing Surgical Management for Rhegmatogenous Retinal Detachment in Eyes with Active Retinoblastoma: A Safety-Driven Approach.

Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12-180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread.

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.

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

Comparison of complications of intrascleral fixation according to the extent of vitrectomy

BackgroundIntraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques.MethodsThis retrospective study included 235 eyes that underwent intrascleral fixation surgery at our hospital between July 2014 and January 2021. The eyes were classified into the anterior vitrectomy group (A-vit group; 134 eyes) and the pars plana vitrectomy group (PPV group; 101 eyes). The age, preoperative and postoperative best-corrected visual acuity, observation period, preoperative and postoperative intraocular pressure, and the incidence of intraoperative and postoperative complications were assessed.ResultsIntrascleral fixation was performed more frequently in the PPV group, and a significant difference was observed between the eyes with a history of vitrectomy and eyes with scleral buckles (p = 0.00041). In terms of the incidence of postoperative complications following intrascleral fixation, the incidence of low intraocular pressure postoperative was higher in the PPV group than that in the A-vit group, and a significant difference was observed between the two groups (p = 0.01).ConclusionsThe visual outcome and complications following intrascleral fixation did not differ according to the extent of vitreous excision.

SPONTANEOUS RESOLUTION OF SUBFOVEAL PERFLUOROCARBON: CASE REPORT AND REVIEW OF THE LITERATURE

Purpose: To report a case of spontaneous resolution of subfoveal perfluorocarbon liquid (sPFCL). Methods: A 72-year-old male presented with poor vision in the left eye for two months. Ophthalmic examination revealed a visual acuity of counting fingers at 40 cm, pseudophakia, and rhegmatogenous retinal detachment in the left eye. The patient underwent 23G pars plana vitrectomy associated with a scleral buckle and silicone oil. Postoperatively, a retained sPFCL bubble was observed on OCT image. Results: Postoperatively, the sPFCL bubbles disappeared spontaneously by a full-thickness macular hole. Four weeks after surgery, the macular hole was closed, and visual acuity improved with preservation of foveal depression. Conclusion: Because spontaneous resolution rarely occurs, retinal surgeons prefer early evacuation of sPFCL. Herein, we report a new case of spontaneously resolved sPFCL and discuss the mechanisms for its resolution reported in the literature.

Scleral buckle infection due to Nocardia cyriacigeorgica

A 34-year-old male complained of pain, discharge, and foreign body sensation in the right eye (RE) for 1 week. On anterior segment examination, RE had conjunctival congestion with an exposed buckle at 12 o’clock and buckle sutures covered with thin conjunctiva in the other quadrants. A diagnosis of an exposed and infected scleral buckle in RE was made, and buckle explant removal was done. Culture isolated Nocardia cyriacigeorgica from the explant. This case highlights the importance of surgeons being aware of Nocardia’s potential to cause buckle infection, its delayed manifestation, the need for timely diagnosis using microbiology, appropriate treatment using sensitive antibiotics, and proper follow-up.

Management of traumatic dislocated polymethyl methacrylate intraocular lens following globe rupture in a monocular patient: A case report

A 72-year-old monocular male with no light perception in the left eye and a history of cataract extraction with polymethyl methacrylate (PMMA) intraocular lens (IOL) implantation and retinal detachment repair with scleral buckling in the right eye presented after a forward fall and hitting his face with a large iris defect, irregular pupil, superior zone 2 globe rupture, dense vitreous hemorrhage, and a 1-piece PMMA IOL dislocated in the posterior chamber in the right eye. His visual acuity on presentation was hand motion with directionality, with no improvement on pinhole. PMMA IOLs are difficult to cut and require larger incisions for removal, which was difficult in our patient with open-globe rupture. His large iris defect and minimal capsular support ruled out other options such as the implantation of a new IOL. IOL repositioning with scleral suturing resulted in the successful salvation of his IOL and visual acuity.

Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes.

Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes. To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD. Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal. Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 - 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 - 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment. PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.

Surgical Outcomes of Retinal Detachment in Knobloch Syndrome

To describe the rate, characteristics, and outcomes of rhegmatogenous retinal detachment (RD) in patients with Knobloch syndrome. A single-center retrospective cohort study. 50 patients with Knobloch syndrome diagnosed clinically with or without molecular confirmation of recessive pathogenic COL18A1 variants. A retrospective chart review of all patients diagnosed with Knobloch syndrome from November 1st, 1983, to March 31st, 2023. Demographic data, ophthalmic evaluation at baseline and follow-up, interventions, and final anatomic and visual outcomes were collected. Rate, time of onset, characteristics, and treatment outcomes of RD. Fifty patients with Knobloch syndrome were included. Males constituted 56% of cases. The diagnosis was confirmed with molecular genetic testing in 37 (74%) patients. 22 patients (44%) had documented occipital bony defects or scalp lesions. Forty-eight of 100 eyes (48%) developed RD at a mean age of 6.5 (SD = 6.1) years. The mean follow-up was 7.7 (SD = 5.6) years [range 6 months - 24.3 years]. Macular hole-related RD comprised 33% of RD cases. The overall single surgery success rate was 36% and the final anatomical success rate was 70%. Macular hole-related RD carried a slightly worse prognosis with a 58% final anatomical success rate. Vitrectomy with adjunct scleral buckle and silicone oil tamponade provided the highest single surgery success (62.2%). In eyes with measurable best corrected visual acuity (BCVA), the mean preoperative BCVA was 1.2 logMAR (Snellen equivalent 20/320). After successful repair, mean VA was 1.3 logMAR (Snellen equivalent 20/500). Retinal Detachment in Knobloch syndrome is frequent and occurs in young children. Macular hole retinal detachment comprises one-third of RD cases and requires careful macular evaluation. Vitrectomy, combined with scleral buckling and silicone oil tamponade appear to provide the best anatomical outcomes.

A Case of Posner-Schlossman Syndrome following after Strabismus Surgery

Purpose: To report one case of Posner-Schlossman syndrome following after strabismus surgery.Case summary: A 21-year-old male patient with a previous history of scleral buckling due to rhegmatogenous retinal detachment in right eye, underwent left lateral rectus muscle recession and medial rectus muscle resection surgery for the intermittent exotropia. He complained of blurred vision and pain in the left eye starting from the day after the surgery. When he visited the clinic on the fourth day post-surgery, his best corrected visual acuity was 20/50 and intraocular pressure was 44 mmHg in the left eye. Slit lamp examination revealed corneal edema, 2+ anterior chamber cells, deep anterior chamber, and an open angle in the left eye. After treatment with antiglaucoma eyedrops and steroid eyedrops, the intraocular pressure decreased to 13 mmHg. There were no signs of recurrence during the two-month follow-up period.Conclusions: Posner-Schlossmann syndrome, which occurs after strabismus surgery, must be diagnosed early and treated immediately.

The practical and educational value of scleral buckling with chandelier illumination.

To compare the surgical results in cases of primary rhegmatogenous retinal detachments between standard scleral buckling (SSB) and scleral buckling with chandelier illumination (SBC) and to analyse the differences in SBC surgical results between an experienced ophthalmologist and inexperienced ophthalmologists. Consecutive surgical case series of 155 eyes that underwent scleral buckling were retrospectively reviewed and divided into four groups: SSB performed by an experienced ophthalmologist (n = 54), SBC performed by an experienced ophthalmologist (n = 52), SBC performed by inexperienced ophthalmologists (n = 40) and SSB performed by inexperienced ophthalmologists (n = 9). Then, these four groups were compared. No significant differences were observed between SSB and SBC procedures both performed by the experienced ophthalmologist with regard to demographics, preoperative findings, contents of the surgery, intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SBC performed by the experienced ophthalmologist and SBC performed by the inexperienced ophthalmologists, no significant differences were found regarding intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SSB and SBC procedures both performed by the inexperienced ophthalmologist, a significant difference was found regarding intraoperative complications. There were no significant differences in surgical results between SSB and SBC when both were performed by the experienced ophthalmologist. In addition, the surgical results were equal between the experienced ophthalmologist and the inexperienced ophthalmologist as far as SBC was concerned. Learning scleral buckling skills by using SBC is a reasonable course of action for inexperienced ophthalmologists.

Сравнение кругового экстрасклерального пломбирования и ретинотомии в витреоретинальной хирургии «нижних» рецидивов отслоек сетчатки при выраженной стадии передней пролиферативной витреоретинопатии

Purpose. To analyze the results of the treatment of recurrent inferior rhegmatogenous retinal detachments (RRD) complicated by the severe stage anterior proliferative vitreoretinopathy (PVR) in silicone oil (SO) tamponade eyes depending on the volume of surgical intervention: pars plana vitrectomy (PPV) with encircling scleral buckling (SB) versus PPV with retinotomy (RT). Material and methods. 66 patients (66 eyes) with recurrent inferior RRD by the severe stage anterior PVR in silicone oil-filled eyes were included in this retrospective study who were treated in our clinic from 2017 to 2022. 66 eyes were alternatively distributed between 2 groups: PPV with SB (30 eyes), PPV with RT (36 eyes). The outcome measures were anatomical success, which was defined as complete anatomical retinal reattachment and function — best corrected visual acuity (BCVA). Results. 66 patients (66 eyes), 36 men and 30 women, median age 60.0 (50.0; 69.0) years, were included in the study. After surgical treatment, anatomical success was similar in both groups with no statistically significant difference (p = 0.7). When conducting a comparative analysis between the two groups 7 days, 3 and 6 months after surgery, BCVA was statistically significantly higher in the PPV+SB group compared to the PPV+RT group (p = 0.0001). Conclusion. For eyes with recurrent inferior RRD, complicated by an advanced stage of anterior PVR, PPV+SB and PPV+RT allow one to achieve the same anatomical results. According to the functional results, PPV+SB may be a better choice as an alternative to PPV+RT with a statistically significant difference (p = 0.0001). Keywords: recurrence of retinal detachment, scleral buckling, retinotomy, pars plana vitrectomy, silicone tamponade, anterior proliferative vitreoretinopathy

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

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

Outcomes and variables that impact pneumatic retinopexies.

To evaluate the efficacy of pneumatic retinopexy (PR) in patients undergoing PR as primary treatment for rhegmatogenous retinal detachment (RRD) and analyze the factors associated with success and failure in the studied population. A retrospective chart review was done of patients with RRD treated with PR as primary management method treated at New York Eye and Ear Infirmary of Mount Sinai between January 2017 and December 2021. Primary outcome measured success or failure of PR. Secondary outcome measured best corrected visual acuity (BCVA) after PR. A separate risk analysis was done to identify and stratify risks associated with success and failure of PR. A total of 179 eyes from 179 patients were included for final analysis. The 83 patients (46.37%) achieved anatomical reattachment of the retina after primary PR with no need for additional surgery. The 96 patients (53.63%) had a failed primary PR and required a PPV and 6 of them required pars plana vitrectomy (PPV) with scleral buckle (SB). In total, 19 cases (10.61%) were done as temporizing pneumatics, 18 (94.74%) underwent PPV, and 1 (5.26%) did not require further intervention. The visual acuities at postoperative month 1 (POM1) for patients who underwent primary PR successfully and for those that underwent PPV after, were 0.58 (20/80) and 1.03 (20/200) respectively. Patients who met Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria had a statistically significant decreased risk of primary PR failing (hazard ratio 0.29, P=0.00). Majority of missed or new breaks were found superotemporally. PR is a good treatment option for treating RRDs in patients that meet PIVOT criteria and can be conducted as a temporizing measure. PIVOT criteria and fovea on status decrease the risk of PR failure.