Scleral Buckling For Retinal Detachment Research Articles

COST ANALYSIS OF SCLERAL BUCKLE, PARS PLANA VITRECTOMY, AND PARS PLANA VITRECTOMY WITH SCLERAL BUCKLE FOR RETINAL DETACHMENT REPAIR.

To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment repair. Cost-utility analysis using data from the Primary Retinal Detachment Outcomes Study. The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year for treatment of moderately complex rhegmatogenous retinal detachment with SB, PPV, or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ambulatory surgery center settings. Total costs (2020 US dollars) for repair of a moderately complex rhegmatogenous retinal detachment in hospital (ambulatory surgery center) settings were $5,975 ($3,774) for the SB group, $8,125 ($5,082) for the PPV group, and $7,551 ($4,713) for the PPV/SB group. The estimated lifetime quality-adjusted life years gained were 5.4, 4.7, and 4.7 in the SB, PPV, and PPV/SB groups, respectively. The cost per quality-adjusted life year for hospital and ambulatory surgery center settings was $1,106 a ($699) for the SB group, $1729 ($1,081) for the PPV group, and $1,607 ($1,003) for the PPV/SB group. Scleral buckle, PPV, and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex rhegmatogenous retinal detachment, with slightly better results for SB, compared with current willingness to pay standards.

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.

Intraocular currents, Bernoulli's principle and non-drainage scleral buckling for rhegmatogenous retinal detachment.

For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks remain open at the end of surgery. Various explanations have been put forward, but none more interesting than the effect of fluid currents associated with eye movements. One such explanation involved the physics of the Bernoulli's principle. Daniel Bernoulli was an eighteenth century Swiss mathematician and he described an equation based on the conservation of energy. The sum of pressure energy, potential energy and kinetic energy remains constant. Bernoulli's equation usually applies to closed system such as the flow of fluid through pipes. When fluid flows through a constriction, the speed of fluid increases, the kinetic energy increases. If there was no change in elevation (potential energy), then the increase in kinetic energy must be accompanied by a decrease in pressure energy. In ophthalmic surgery, the Bernoulli's effect is the basis for venturi pumps that drive vitrectomy and phacoemulsification machines. This essay expounds on how Bernoulli's effect might be relevant to scleral buckling for retinal detachment repair. In the era when vitrectomy is increasing the primary surgical operation for retinal detachment, the pervasive advice is to emphasise the importance of patient adopting head posture and remaining still postoperatively. The exception is non-drainage scleral buckling surgery. Early postoperative mobilisation may be vital to achieve reattachment.

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.

The Royal College of Ophthalmologists’ National Ophthalmology Database Study of vitreoretinal surgery: report 5, anaesthetic techniques

AimsTo explore trends over time and variation in the use of anaesthetic techniques for vitreoretinal (VR) surgery in the UK.MethodsProspectively collected data from 13 centres contributing >50 VR operations, including...

A Case ofPseudomonas aeruginosaInfection after Scleral Buckling for Retinal Detachment

Purpose: To report a case of Pseudomonas aeruginosa infection after scleral buckling for retinal detachment. Case summary: A 68-year-old male presented with a 2-day history of pain in the right eye. The patient had a history of scleral buckling for retinal detachment 10 years earlier and excisional biopsy for conjunctival mass 1 month previously. Biopsy revealed chronic inflammation and granulation tissue formation. Slit-lamp examinations revealed superior conjunctival injection, edema and exposed suture knot. Fundus examination revealed exudative retinal detachment and choroidal detachment. The conjunctival lesion did not improve although the patient was treated with moxifloxacin. After 4 days, bacterial and fungal cultures were performed because the conjunctiva presented with purulent discharge 4 days after treatment. The scleral buckle and suture knot were removed. The cultures revealed growth of Pseudomonas aeruginosa. According to antibiotic sensitivity test results, the authors treated the patient with ceftazidime. The conjunctival lesion, choroidal detachment and exudative retinal detachment were improved. Conclusions: In patients with conjunctival injection, edema, purulent discharge and ocular pain after scleral buckling, presence of infection should be suspected. If scleral buckle infection is suspected, bacterial culture, antibiotics treatment and scleral buckle removal should be considered. J Korean Ophthalmol Soc 2015;56(10):1646-1649

Encircling Narrow Band versus Buckle for Retinal Detachments with Intrabasal or Unseen Retinal Breaks.

Purpose:To compare the results of narrow encircling band surgery with standard encircling scleral buckling for retinal detachments (RDs) with intrabasal or unseen breaks.Methods:In a retrospective study, eyes with intrabasal or unseen breaks underwent narrow band implantation (group N) or standard encircling buckling plus wide tire placement (group W) and were followed for at least one year.Results:A total of 112 eyes including 39 eyes in group N and 73 eyes in group W were studied. Preoperatively visual acuity of eyes in group N was significantly better (1.55 ± 0.9 vs. 1.93 ± 0.9 logMAR, P = 0.043). The two study groups (N and W) were comparable in terms of the extent of RD (2.8 ± 0.96 vs. 2.8 ± 0.93 quadrants), interval to surgery (88.3 ± 176.4 vs. 71.9 ± 135.4 days) and percentage of visible breaks (56.4% vs. 63%), respectively (all P values > 0.05). More atrophic holes were present in group W and more dialyses were reported in group N. The single operation success rate at 12 months was 69.2% in group N and 74% in group W (P = 0.1). The single operation success rate for eyes with unseen breaks was also comparable (66.7% vs. 85.7%, P = 0.157). Final corrected visual acuity was also similar (0.63 ± 0.44 vs. 0.85 ± 0.69 log MAR). The only factor influencing success rate was the type of retinal breaks (P = 0.04). Type of scleral buckling did not affect the single operation success rate (P = 0.460).Conclusion:Narrow encircling band surgery is a possible option with acceptable single operation success rate for RDs with intrabasal or unseen breaks.

Prophylactic Scleral Buckle Implantation in Knobloch Syndrome

Knobloch syndrome is a rare autosomal recessive disorder characterized by a triad of high myopia, vitreoretinal degeneration, and congenital occipital scalp defects. On literature review of all reported cases, 25 of 85 eyes (29%) of patients diagnosed as having Knobloch syndrome have suffered retinal detachment. Due to high myopia, surgical repair of the retinal detachment is challenging and patients frequently require several reoperations. Even after vitrectomy or scleral buckle for retinal detachment, the final visual acuity outcomes are poor, with 11 of 12 (92%) patients having 20/200 visual acuity or worse and 6 of 12 (50%) having counting fingers visual acuity or worse. The role of retinal detachment prophylaxis has been discussed for other vitreoretinal degeneration disorders, but not for this disease. The authors report the case of a child affected with Knobloch syndrome who presented with total retinal detachment in the left eye at 24 months of age. He underwent successful repair and was then treated with prophylactic scleral buckle implantation in the right eye 5 months later. The retina in both of his eyes remains attached 4 years later. [J Pediatr Ophthalmol Strabismus 2014;51:e40–e43.]

Combined Baerveldt Glaucoma Implant and Scleral Buckling Surgery for Patients With Retinal Detachment and Coexisting Glaucoma

To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral buckling surgery for patients with glaucoma requiring a scleral buckle for retinal detachment repair. Retrospective, consecutive, noncomparative, and interventional case series of 30 eyes (30 patients) that underwent simultaneous scleral buckle and BGI surgery, using a staged (group 1, n=21 patients) or nonstaged (group 2, n=9 patients) approach to BGI implantation. Successful intraocular pressure (IOP) control was defined as 6 mm Hg≤IOP≤18 mm Hg. Although not statistically significant, mean best corrected visual acuity (LogMAR) improved from 2.0 before surgery to 1.7 after surgery (P=0.13) with a mean follow-up of 27.7 months. Of the 21 patients in group 1, only 13 (62%) required second-stage tube insertion at a mean of 7.0±8.0 months (range, 1 to 24 mo) postoperatively. For these eyes combined with group 2 eyes, mean IOP was reduced from 31.1±10.8 to 12.7±6.0 mm Hg (P<0.0001), and the mean number of glaucoma medications was reduced from 2.9±1.4 to 1.2±1.3 (P<0.001). Life table rates of successful IOP control were 90% and 80% at 12 and 24 months, respectively. Combined scleral buckle and BGI is an effective technique for managing coexisting glaucoma and retinal detachment and provides the clinician with a useful surgical option while minimizing surgical risk.

Scleral buckling for retinal detachment in Ibadan, Sub-Saharan Africa: anatomical and visual outcome

BackgroundScleral buckle surgery is not a commonly performed surgical procedure in Sub-Saharan Africa due to a paucity of trained vitreo retinal surgeons. The aim of the study was to review sclera buckle procedures with a view to evaluating the anatomical and visual outcomes.MethodsCase records of patients that had scleral buckle surgery at the Retina Unit of the University College Hospital, Ibadan, Nigeria, between 2007 and 2010 were reviewed. Information retrieved included patients’ demographics, duration of symptoms, and presenting vision. Other information included site of retinal break, extent of retinal detachment, involvement of the fellow eye, and macular involvement. Postoperative retina reattachment and postoperative visual acuity were also recorded. Proportions and percentages were used to analyze data.ResultsForty five eyes of 42 patients were studied with a male to female ratio of 1.6:1. The mean age was 47.7 years (±17.6 years). The median duration before presentation was 3 months (range: 5 days – 156 months). Subtotal retinal detachment was found in 35 eyes (77.8%) while total retinal detachment occurred in ten eyes (22.2%). Thirty four eyes (75.6%) had “macular off ” detachments. At 6 weeks, there was an improvement in visual acuity in 23 eyes (51.1%), while visual acuity remained the same in nine eyes (20%) and was worse in 13 eyes (28.9%). Anatomical attachment was seen in 43 eyes (95.6%) on the operation table, in 40 eyes (90.9%) at first day postoperatively and in 32 eyes (86.5%) at 6 weeks after surgery.ConclusionOutcome of sclera buckle surgery for rhegmatogenous retinal detachment may be improved in developing countries of Sub Sahara Africa if adequate awareness is created to educate the populace on early presentation.

Transcleral posterior chamber paracentesis for angle closure glaucoma secondary to posterior chamber gas entrapment after intravitreal c3f8 injection in a phakic eye.

The purpose of this study was to describe a new technique for treating a case of angle closure glaucoma secondary to posterior chamber (PC) gas entrapment after intravitreal C3F8 injection. Retrospective case report. A 26-year-old woman received intravitreal injection of 0.4 mL of C3F8 after segmental scleral buckling for retinal detachment of her phakic eye. Prone positioning was not maintained postoperatively, and severe eye pain developed within hours of surgery. Intraocular pressure increased to 50 mmHg, and PC was found to be filled with gas accompanying with 360° iridocorneal apposition and angle closure. Transcleral PC paracentesis was performed to evacuate the gas. Anterior chamber angle was reopened inferiorly, and intraocular pressure dropped to 13 mmHg immediately and remained normal. No evidence of lens or iris damage was noted. Postoperatively, the vision improved to 20/25 without major sequelae. Posterior chamber gas entrapment with anterior chamber collapse is a rare complication of intravitreal gas injection in phakic eyes. Transcleral PC paracentesis is a safe way to treat angle closure glaucoma secondary to PC gas entrapment.

This issue of Acta, printed and electronic

The illustrations on the cover show adaptive optic images of photoreceptor pattern in the retina as well as infrared reflectance and high definition spectral domain optical coherence tomography images described in the letter by Massamba et al. in the electronic part of the journal. Witmer et al. in Florida review acute retinal necrosis and emphasize that in addition to retinal detachment, macular edema and ischemia, optic neuropathy is an important component. Seland et al. in Norway and several European countries found that visual impairment in Europe was <3% in prevalence and blindness ranged in prevalence from 0.5% to 2%, more in southern than northern Europe. Falk et al. in Finland report that intraocular pressure decreases by about 3 mmHg following cataract surgery and remains at this level for 4 years. Yoshino et al. in Tokyo found good and stable visual outcome with a refractive aspheric silicone multifocal intraocular lens. Heussen et al. in Germany, UK and Switzerland compared vitrectomy and scleral buckling for retinal detachment. In phakic eyes vitrectomy has more reoperations, whereas in pseudophakic eyes scleral buckling has more reoperations than vitrectomy. Velikay-Parel et al. in Austria used encircling band, laser, perfluorcarbon and silicone oil for complicated retinal detachments with proliferative vitreoretinopathy. Yeh et al. in Taiwan found that intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous hemorrhage after diabetic retinopathy. Matri et al. in Tunisia found bevacizumab to be useful for choroidal neovascularization in angioid streaks. Mekjavic et al. in Slovenia report good results with 3 monthly bevacizumab injections followed by OCT guided continuous treatment for neovascular age-related macular degeneration. Degenring et al. in Germany attempted to translocate retinal pigment epithelium and choroid to treat neovascular AMD, with variable and disappointing results. Rojas et al. in Spain found that treatment with statin reduced choroidal damage and ischemia in hypercholesterolemic rabbits. Teuchner et al. in Austria, Hungary and USA injected brain derived neurotrophic factors and other potentially neuroprotective molecules into the vitreous cavity in rats in order to delay ganglion cell loss. Martinez-de-la-Casa et al. in Spain found that rebound and noncontact tonometry gave similar results as Goldman applanation tonometry and were similarly influenced by central corneal thickness. Wang et al. in Copehagen and China show that cyclooxygenase-2 is expressed in normal human eyes and less so in some eye tumors. Kim et al. in Korea report good outcomes with porous polyethylene orbital implants. Ganesh et al. in Oman and Sweden found that 21% of patients who had esotropia surgery in childhood later developed exotropia. Swan et al. in USA comment on this article in a letter to the editor. Theodossiadis et al. in Athens document spontaneous closure of macular holes. Following is the electronic part of this issue, which is available on http://www.actaophthalmologica.com. Resch et al. in Austria and Germany found that reduced optic nerve head bloodflow is associated with worsening visual field defect and morphological changes in the optic disc. Cause and effect is unclear. Jindal et al. in USA did not find statistically significant improvements in perimetry or multifocal visual evoked potential with acute lowering of intraocular pressure. Thaler et al. in Germany and Poland demonstrate neuroprotective effects of tempol in optic nerve crush in rats. Inoue et al. in Japan found that both refractive and diffractive multifocal intraocular lenses reduced contrast of the retinal image. Filho et al. in Brazil report that intravitreal ranibizumab reduces fluorescein leakage and macular swelling sometimes associated with panretinal photocoagulation. Chrysanthi et al. in Greece and UK measured macular pigment optical density in patients with wet and dry age-related macular degeneration. Alnawaiseh et al. in Germany and USA report that Ni++ and Ca++ channels contribute to transretinal signaling in the mouse. Brignole-Baudouin et al. in France and Italy report that omega 3 and omega 6 fatty acid supplements may improve dry eye symptoms. Gatzioufas et al. in Germany comment on the paper by Fahnehjelm et al. on corneal hysteresis and Fahnehjelm and Chen reply. Swan et al. in USA comment on the strabismus paper by Ganesh et al. in this issue. Larsen et al. Copenhagen describe myofibroma of the orbit in a 1 year old. Massamba et al. in France used adaptive optics to image macular telangiectasia, as seen on the cover of the journal. Gibson et al. in UK describe negatively results in AMD genetics. Zarnowski et al. in Poland used topical bevacizumab to prevent bleb failure following trabeculectomy. Jonas et al. in Germany and Italy used intravitreal bevacizumab successfully for perifoveal telangiectasia. I hope that you find this issue of Acta to be educational and enjoyable. Please take advantage of both the printed and electronic version of the journal. Also keep in mind that older versions of Acta Ophthalmologica are available under http://www.actaophthalmologica.com where you can read interesting publications dating back to the 1920s.

Management of Rhegmatogenous Retinal Detachment With Coexistent Macular Hole in the Era of Internal Limiting Membrane Peeling

To review outcomes of vitrectomy plus or minus scleral buckling for retinal detachment (RD) attributable to peripheral break(s) with noncausal macular hole, plus or minus internal limiting membrane (ILM) peeling. Retrospective chart review. Forty-nine consecutive patients from March 1, 1998 to March 31, 2009 with RD attributable to peripheral break and macular hole were treated by vitrectomy. Five had no scleral buckle placed. Forty-three underwent ILM peeling. The main outcome measures were retinal reattachment, macular hole status, and vision. Final retinal reattachment rate was 95.9% (47/49) with 1 and 100% with 2 operations. Final macular hole closure rate was 39/43 with ILM peeling (90.7%), and 2/6 without (33.3%, P value = .0041). Mean final acuity was 20/120, and 20/100 if the macular hole was closed. Vitrectomy, plus or minus scleral buckle, with ILM peeling is effective for repair of RD with macular hole. ILM peeling can increase the rate of macular hole closure.

Trabeculectomy With Biodegradable Collagen Material: A Report of Two Cases

Purpose: To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients. Case summary: The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling, the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (Cosopt, Xalatan). In the second case, IOP was increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (Combigan). Conclusions: Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.

Diplopie dans les suites du traitement chirurgical de décollement de rétine par cryo-indentation

Diplopia is a well-known complication of scleral buckling for retinal detachment. It is generally caused by ocular motility disturbances. We conducted a retrospective study on patients operated on for retinal detachment between 1998 and 2006 at Strasbourg University Hospital (France) who secondarily complained of diplopia. Patient history, scleral buckling type, and early and late postoperative complications were described. Among 821 patients who underwent scleral buckling, 12 developed diplopia lasting more than 3 months. Six of the scleral buckling operations were vertical, three horizontal, and three oblique. Examination of the 12 patients showed seven cases of hypertropia, two cases of hypertropia associated with esotropia, one case of hypertropia with exotropia, and two cases of exotropia. The scleral buckle was removed in first intention in all 12 patients; binocular single vision was restored in six cases. Secondarily, prism correction restored binocular vision in three additional patients. Strabismus surgery was necessary for the remaining three patients. Diplopia following retinal detachment usually responds to simple measures. In our study, the removal of the buckle restored binocular vision in the majority of cases, a prism correction was useful for the remaining patients. Strabismus surgery was often very efficient. Diplopia complicating scleral buckling generally responds to simple treatments that can eliminate a handicapping functional deficit.

Transconjunctival retinopexy with active external drainage of subretinal fluid: a prospective pilot study of eight consecutive cases

To describe an alternative surgical technique for the management of retinal detachment with no or minimal proliferative vitreoretinopathy (grade B) using transconjunctival retinopexy with active external drainage of subretinal fluid. In a prospective, interventional study, eight consecutive patients with retinal detachment with no or minimal proliferative vitreoretinopathy (grade B) underwent transconjunctival retinopexy with active external drainage of subretinal fluid. Transconjunctival external drainage of subretinal fluid was achieved by using a 29 gauge needle placed in the subretinal space under indirect ophthalmoscopic monitoring. Active suction was performed (500 mmHg vacuum) using a vitrectomy line coupled to the needle. After retinal reattachment, cryotherapy was applied to the scleral region corresponding to the area of the retinal break(s). In all cases there was retinal attachment at the end of surgery. Retinal redetachment occurred in four pseudophakic patients who then underwent pars plana vitrectomy. The four phakic patients maintained retinal attachment during follow-up (13-20 months). Transconjunctival retinopexy with active external drainage of subretinal fluid represents a useful, faster, and cheaper alternative to scleral buckling for retinal detachments with no or minimal proliferative retinopathy in phakic patients and, unlike scleral buckling, is not associated with induced myopia.

Vitrectomy with and without scleral buckling for retinal detachment

To compare the surgical results of vitrectomy with and without scleral buckling for rhegmatogenous retinal detachment (RD). Fifty-one patients with rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) at different stages were submitted to pars plana vitrectomy as the primary surgery, 23 patients (45.09%) with scleral buckle (group I) and 28 (54.90%) without scleral buckle (group II). Visual acuity, anterior segment complications, intraocular pressure, strabismus and retina reattachment rate were evaluated in both groups. The anatomical success and postoperative complications were similar in both groups. Retinal reattachment was achieved in 20 of 23 eyes (87%) of group I and in 24 of 28 eyes (85.7%) of group II after the initial surgery (p=1.000). Elevated intraocular pressure was noted in 2 eyes (8.7%) of group I and 1 eye (3.6%) of group II (p=0.583). Corneal abnormalities were seen in 3 eyes (13%) of group I and 2 eyes (7.19%) of the group II (p=0.647). Visual acuity improved from a preoperative median of 20/200 to a median of 20/100 in group 1 and from 20/400 to 20/100 in group 2; the difference between the two groups was statistically significant (p<0.05). The mean follow-up period was 10 months, ranging from 6 to 18 months. Both surgical procedures had similar reattachment rates. Intra- and postoperative complications were similar considering both procedures. Visual acuity improved significantly in group 2 (vitrectomy without scleral buckling).

Particularités du traitement chirurgical du décollement de rétine du myope fort de plus de 10 dioptries et son risque hémorragique: À propos de 79 cas

We report a series of 79 eyes undergoing primary surgery for rhegmatogenous retinal detachment associated with severe myopia greater than 10 diopters. Specific surgical procedures are recommended for these patients in order to minimize the high incidence of postoperative hemorrhagic complications.Seventy-nine eyes of 76 patients treated for retinal detachment with severe myopia greater than 10 diopters were reviewed. Scleral buckling was performed in 21 eyes and pars plana vitrectomy in 58 eyes.After a mean follow-up period of 23.8 months, the final anatomical success rate was 93.7% (74 cases). Postoperative hemorrhagic complications (suprachoroidal hemorrhage and vitreous hemorrhage) occurred in four cases after scleral buckling and in ten cases after vitrectomy.In this study, primary scleral buckling for retinal detachment was less frequently performed than vitrectomy. Broad scleral buckling may not be associated with higher postoperative hemorrhagic complications, when the buckle does not extend over six clock hours. Postoperative hemorrhagic complications also occurred after vitrectomy; however, scleral buckling associated with vitrectomy does not seem to increase the complication rate.This retrospective study of 79 cases of rhegmatogenous retinal detachment with severe myopia higher than 10 diopters suggests that vitrectomy is often considered a primary procedure. Broad scleral buckling associated with vitrectomy is a safe and effective procedure, with an acceptable incidence of complications when not extending over six clock hours.

Retinopathy of Prematurity: The Life of a Lifetime Disease

To provide information on retrolental fibroplasias (RLF), later known as retinopathy of prematurity. Review of the literature on the subject and a first-person account of what was then RLF by one of the authors (A.P.) who was involved in the earliest days in research regarding RLF. MEDLINE search on the topics of RLF and retinopathy of prematurity plus a first-person historic review of original work that dealt with RLF. In 1942, elevated levels of oxygen were thought to play a major role in the development of the disease; at that time, no treatment was available. During the lifetime of this disease, other possible causes have been investigated. These include vitamin E as a prophylaxis against retinopathy of prematurity and the efficacy of light reduction to prevent retinopathy of prematurity. It has been shown that the light reduction does not play a role in reducing the progression of retinopathy of prematurity. Vitamin E studies were inconclusive; some studies show a positive effect and others do not. A major advance occurred with the development of the International Classification of Ophthalmology in 1984, which laid the groundwork for collaborative studies to determine whether cryotherapy of the avascular zone of retina would reduce the incidence of blindness in newborn infants, when compared with control subjects. The study showed that cryotherapy was effective; this was followed by laser photocoagulation when lasers became portable enough to take to the neonatal intensive care unit. At the same time, improved surgical techniques moved from scleral buckling for retinal detachment to vitrectomies (some lens sparing) for more desperate cases that had progressed to stage 4 and stage 5 retinopathy of prematurity. Late changes in adults who were born before any treatment and are now baby boomers ran the gamut from the dragging of the retina in the posterior pole to retinal detachment, cataract, and myopia. Retinopathy of prematurity is a lifetime disease for which preventive and better treatment modalities continue to evolve.

Severe strabismus after scleral buckling: Multiple mechanisms revealed by high-resolution magnetic resonance imaging

Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify a spectrum of mechanisms of strabismus occurring after scleral buckling. Prospective, noncomparative, observational case series in an academic referral setting. Six patients with long-standing, large-angle strabismus after monocular or binocular scleral buckling. Horizontal and vertical preoperative deviations, present from 8 to 120 months, ranged from 25 prism diopters to more than 90 prism diopters. Multipositional high-resolution MRI of both orbits was performed using surface coils in multiple, controlled gaze positions. Coronal, sagittal, and axial images were obtained as clinically appropriate. Different mechanisms of pathologic characteristics of the extraocular muscles (EOMs) in complicated strabismus after scleral buckling. Magnetic resonance imaging readily demonstrated EOM size and contractility, as well as features of scleral buckle hardware such as grooves and junctions and relationships of EOMs to the buckle and sclera. Imaging demonstrated that 5 rectus EOMs were disinserted from the globe at the buckle: 2 superior rectus, 2 medial rectus, and 1 lateral rectus. One patient with suspected inferior rectus muscle disinsertion had restrictive strabismus as a result of interference by a meridional explant and myopic staphyloma. Magnetic resonance imaging demonstrated anterior migration and transection by the silicone element through rectus EOMs in 3 patients. Disinserted EOMs were retrieved successfully by transconjunctival surgery in 4 patients and by orbitotomy in 1 patient, markedly improving alignment even as long as 5 years after EOM disinsertion. Multipositional high-resolution MRI provides valuable information such as location and contractile potential of disinserted EOMs, as well as mass effect from the scleral buckle. Preoperative orbital MRI may be a useful tool to distinguish multiple mechanisms of persistent severe strabismus after scleral buckling and is helpful in surgical planning.