BackgroundTo evaluate the surgical results of scleral buckling (SB) combined with a noncontact wide-angle viewing system with a cannula-based 25G endo-illumination for the management of rhegmatogenous retinal detachments (RRDs) with subretinal proliferation, as well as undetected retinal breaks, in young adults, to explore characteristics of the undetected breaks.MethodsThe medical records of 26 young RRD patients with undetected retinal breaks and subretinal proliferations who underwent encircling using an SB combined noncontact wide-angle viewing system with a cannula-based 25G endo-illumination were assessed, as were their follow-ups at 1 and 6 months after surgery.ResultsRetinal breaks were found and treated in 24 (92.3%) of the patients. The breaks were mainly located in the inferior quadrant (66.7%) in the break-detected patients, especially in the inferotemporal quadrant (58.3%). The anatomical successes were 76.9% (20/26 patients) at day 1, 88.5% (23/26 patients) at 1 month, and 100% (26/26 patients) at 6 months after surgery. All patients achieved visual acuity improvements at 6 months (0.39 ± 0.18 logMAR units) after surgery, when compared with their perioperative visual acuities (0.75 ± 0.48 logMAR units).ConclusionsIn this series, endo-illumination-assisted SB appeared feasible for managing chronic RRDs with undetected breaks and subretinal proliferations. Attention to the inferior quadrant, especially in the inferotemporal quadrant during surgery, may be helpful in treating patients with undetected breaks.

To establish a retinal break localization (RBL) formula and determine its reliability and influencing factors. A trigonometric function was used to develop a formula for the distance CB from the limbus (C) to the apex of the retinal breaks (B) based on a model eye, ultra-wide-field fundus (UWF) images, and optical biometric data. The CB values of 43 eyes were compared with the measurement obtained during operation, CB1. The influential and correlating factors analyzed were the axial length (AL), types of the break, macula (off or on), anterior chamber depth (ACD), and white to white corneal diameter (WTW) measurements. Compared to CB1, CB was longer in the group of all cases (p = 0.032) and the groups with AL ≥ 26mm (p = 0.007). In the three other AL groups (AL < 26, 25, 24mm), there were no significant differences between CB and CB1 (p = 0.200, 0.599, 0.246). The categories of the breaks and macula had no significant effect on the reliability of the formula (p = 0.121, 0.085). There was a positive correlation between the AL and the difference between CB and CB1 (Pearson correlation = 0.662, p < 0.001). The proposed formula has value for locating retinal breaks in cases of AL less than 26mm and provides a new quantitative metric.

PurposeThis study evaluated the effectiveness of scleral taping combined with C3F8 gas filling for the management of complex retinal detachment (CRD) and to objectively assessed its clinical value.MethodsForty consecutive patients (40 eyes) with CRD who underwent surgical treatment were included. Patients were divided into two groups: the study group underwent scleral buckling (SB) combined with C3F8 gas filling, and the control group received scleral buckling alone. Each group comprised 20 patients (20 eyes). After anaesthesia, traction sutures were placed at the rectus muscle in all patients. Retinal breaks and degenerative areas were examined and treated with cryotherapy. A silicone sponge was positioned on the scleral surface, and the sutures were tightened to produce an indenting effect. Additionally, patients in the study group received an intravitreal injection of C3F8 gas.ResultsBoth uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) improved in the study and control groups on the first post-operative day. However, the improvement was statistically significant only in the control group. Visual acuity in both groups improved significantly at 1 week, 1 month, and 3 months post-operatively compared with baseline and the first post-operative day. Intraocular pressure (IOP) in the study group was significantly elevated at 1 week, 1 month, and 3 months post-operatively compared with baseline. The retinal reattachment rate was 95% in the study group, significantly higher than 70% in the control group. The recurrence rate was 5% in the study group. No serious complications, including retinal incarceration, haemorrhage, anterior segment ischemia, or infection, were observed in either group.ConclusionScleral buckling combined with C3F8 gas filling is a safe and effective treatment for CRD. It significantly improves post-operative visual acuity, enhances retinal reattachment, reduced the recurrence rate with minimal complications.

Aim: To formulate an algorithm for choosing surgical treatment for inferior recurrence of retinal detachments (RD) in eyes under silicone tamponade depending on the stage of APVR. Materials and methods. This study included the results of surgical treatment of 114 patients with inferior recurrence of RD under silicone tamponade of the vitreous cavity with APVR. Patients were divided into three groups depending on the stage of APVR and into six subgroups depending on the tactics of surgical treatment. The main criteria are achieving anatomical success rate and improving visual outcomes were compared postoperatively. Results. An algorithm for choosing surgical treatment for inferior recurrences of RD under silicone tamponade has been formulated depending on the stage of PPVR: at the initial stage of PPVR – performing only scleral buckling (SB); at an advanced stage of PPVR – performing vitreoretinal surgery in combination with SB; at an advanced stage of PPVR – performing vitreoretinal surgery in combination with retinotomy and short-term postoperative tamponade of the perfluorocarbon liquids. Conclusion . The created algorithm for choosing surgical intervention for inferior recurrences of RRD complicated by PPVR, under silicon oil tamponade depending on the stage of PPVR, allows to improve the anatomical and functional results of treatment.

Rhegmatogenous retinal detachment (RRD) remains a leading cause of acute visual loss and requires timely surgical repair. Contemporary epidemiology shows rising RRD incidence worldwide among highly myopic patients [1–4]. First-line surgical management for RRD with superior breaks is debated. Pneumatic retinopexy (PR) offers minimally invasive repair with favorable functional outcomes in well-selected cases; the PIVOT randomized trial demonstrated better visual acuity and less vertical metamorphopsia versus pars plana vitrectomy (PPV), albeit with higher rates of new postoperative breaks and strong dependence on patient compliance with head positioning [6–8; 17–19]. Scleral buckling (SB) remains relevant, especially in phakic eyes due to lower cataract progression risk, while PPV is now the most commonly performed procedure, driven by improved visualization, control of proliferative vitreoretinopathy (PVR), and advances in technology (small-gauge systems, 3D heads-up viewing, intraoperative OCT) [5; 9–11; 20–22]. Choice of tamponade (air, SF6/C2F6/C3F8 gas, silicone oil) should account for break location, PVR grade, and patient positioning; air tamponade is increasingly discussed for uncomplicated superior breaks, whereas long-acting gas or silicone oil remains preferable for giant retinal tears and advanced PVR [13–16; 23–25]. This review synthesizes selection criteria and proposes a pragmatic decision algorithm considering lens status, number and extent of breaks, PVR severity, macular status, and positioning adherence.

To describe in-office suprachoroidal viscopexy (SCVEXY) as a novel adjunct surgical technique with pneumatic retinopexy (PnR) for rhegmatogenous retinal detachment (RRD). A 61-year-old pseudophakic man who was failing PnR for a macula-involving RRD underwent rescue SCVEXY at St. Michael's Hospital, Unity Health Toronto, Toronto, Canada. An injection of suprachoroidal sodium hyaluronate 2.3% (Healon 5, Johnson & Johnson Vision) was performed at five o'clock under the causative retinal tear using a 30 G needle with a custom-made guard that exposed 1 mm of the needle. Following the procedure, a dome-shaped suprachoroidal convexity was present in the inferotemporal quadrant. The patient achieved complete reattachment over 2 days with continued positioning. Laser retinopexy was applied around the causative tear, and the viscoelastic reabsorbed over a period of approximately 2 weeks. The retina remained attached until the final follow-up at 9 months. Suprachoroidal viscopexy (SCVEXY) is a minimally invasive in-office procedure that creates a temporary suprachoroidal buckle that can be used to rescue failing PnR in RRD. It can be particularly useful to close inferior tears, avoiding the need for operating room procedures such as pars plana vitrectomy or scleral buckle. However, there are still limited data on ideal case selection, efficacy, adverse events, and failure rates.

Background:Surgery for stages 4 and 5 of retinopathy of prematurity (ROP) is challenging. The long-term results even in initially successful cases are not satisfactory. Data on long-term results are sparse.Methods:Retrospective analysis of patients with stages 4 and 5 of ROP who underwent surgery at a tertiary care center and had a minimum follow-up of 5 years. Most stage 4 a and 4b were managed by scleral buckling or lens sparing vitrectomy, while most stage 5 needed lens sacrificing vitrectomy. The anatomical success was assessed at 6 weeks postsurgery and again at the last follow-up, while the visual success was assessed only at final follow-up visit.Results:84 eyes of 60 patients with a mean follow-up of 9.27 years were analyzed. The mean age at presentation was more in stage 5 ROP compared to stage 4a and 4b (P < 0.001). Overall anatomical success was seen in 94.2% of stage 4a, 82.35% of stage 4b, and 63.6% of stage 5 at 6 weeks, which deteriorated to 88.2% in stage 4a, 70.59% in stage 4b, and 30.3% in stage 5 at the end of last follow-up. At last visit, the highest level of corrected vision attained was 6/9 in stage 4a, 6/18 in stage 4b, and 6/60 in stage 5 ROP.Conclusions:Anatomical and visual results are better with stages 4a and 4b compared to stage 5 ROP. On long-term follow-up, the incidence of recurrent retinal detachment is highest in stage 5 ROP.

Purpose:To look at the outcomes of various interventions in treatment-naive pediatric rhegmatogenous retinal detachment (RRD).Methods:This study was conducted at a tertiary care hospital in North India. Children below 16 years with treatment-naive RRD with a minimum 6-month follow-up were enrolled retrospectively from July 2012 to June 2021 and prospectively from July 2021 to June 2022. Patient demographics at presentation, risk factors, preoperative ophthalmic findings including best-corrected visual acuity (BCVA), the choice of surgery and tamponade, and postoperative assessment parameters were recorded. The primary outcome measure was anatomical success after surgery. Secondary outcome measures included functional success, that is, postoperative BCVA at last follow-up, improvement in vision, number of surgeries required to achieve final anatomical success, and correlation of factors such as age and etiology with outcomes. Functional success was taken as postoperative BCVA ≥ logMAR 1.3.Results:Among the 333 pediatric patients (348 eyes), the most common etiology was trauma (44.8%), followed by high myopia (17%) and idiopathic causes (15.5%). Primary anatomical success was achieved in 66.9% of cases, improving to 88.5% with additional surgeries. Functional success was recorded in 46.3% of cases. Combined scleral buckling (SB) and pars plana vitrectomy (PPV) provided the best anatomical (66.01%) and functional (48.32%) outcomes.Conclusion:Pediatric RRD presents significant management challenges. Combined SB + PPV yielded superior outcomes. Functional recovery remains limited, emphasizing the need for early detection, improved surgical strategies, and long-term follow-up for optimal visual rehabilitation.

To determine the indications for buckle removal, presenting features, microbiological spectrum and antibiotic sensitivity pattern 2. To determine the rate of retinal detachment following scleral buckle removal. A retrospective observational study was conducted in a high-volume tertiary eye care hospital in Southern India on all patients who underwent SB removal from the years 2009 to 2021 with a minimum follow-up period of 6months after buckle removal. Out of 1132 eyes that underwent Scleral buckling with or without combined or subsequent pars plana vitrectomy during the study period, 52 eyes underwent buckle removal. Thus, the rate of Scleral buckle removal was 4.59%. The most common indication for buckle removal was infection of the explant (71.15%). Microbial growth was demonstrated in 69.23% of eyes. The most commonly isolated pathogenic group of organisms was the Nocardia species (22.22%). Gram positive bacilli was the most common group of organisms detected in samples with bacterial and mixed fungal and bacterial isolates. The highest susceptibility was noted for Vancomycin followed by Cefotaxime, Gentamicin and Chloramphenicol. Amikacin appeared to have lesser efficacy than previously reported. The rate of recurrent detachment post buckle removal was 3.85%. In contrast to previous studies, a preponderance of Nocardia species as the most commonly isolated pathogen was studied. A paradigm shift in antibiotic sensitivity pattern with an emerging resistance to Vancomycin and decreasing efficacy of Amikacin was demonstrated.

To report a case of bilateral rhegmatogenous retinal detachment following pazopanib treatment and the rationale for selecting scleral buckling as the treatment approach. A case report of a 67-year-old woman with clear cell renal cell carcinoma and metastatic progression, who was treated with pazopanib. The patient developed bilateral rhegmatogenous retinal detachment with macular involvement. Scleral buckling was performed on both eyes. Scleral buckling led to immediate and sustained retinal reattachment in both eyes. Postoperatively, the patient developed acute bilateral periorbital inflammation and chronic pain in the left eye. Scleral buckling effectively treated the retinal detachment in this pazopanib-treated patient. It may be a preferred treatment option over pars plana vitrectomy with laser retinopexy, since literature review revealed a case report of failed laser retinopexy in a pazopanib-treated patient. Further research is needed to determine the relationship between pazopanib and postoperative periorbital inflammation and chronic eye pain.

This study aimed to analyze rates of subretinal hemorrhage (SRH), any correlations between SRH and drainage technique (scleral cutdown and external needle drainage) during scleral buckle (SB) surgery, as well as associated structural outcomes. A retrospective analysis was conducted on 351 adult patients undergoing SB surgery, of whom 196 (56%) received SRF drainage, 124 via scleral cutdown and 72 via needle drainage. Data extracted included SRF drainage technique, SRH characteristics, and need for additional surgery. Intraoperative SRH occurred in 19/196 (9.7%) cases, with no significant difference between techniques (P = 0.99). Macular involvement of SRH was observed in 7/19 (37%) cases; all were macula-off preoperatively. SRH size (P = 0.230), resolution time (P = 0.097), and surgeon variability (P > 0.05) were not significantly different based on drainage technique in this relatively small study. Additional surgery occurred in three cases (1.5%). Average best-corrected visual acuity improved from 20/100 to 20/63 at final follow-up. Intraoperative SRH rate was 9.7% and not dependent on surgical technique. Most cases had favorable outcomes and only 1.5% of eyes required further surgical intervention. The overall rate of macula-involving SRH was 3.6% and found only in preoperative macula-off detachments. While significant differences between surgical techniques were not seen, larger studies are required to draw more definitive conclusions.

Purpose: To present long-term changes in swept-source optical coherence tomography angiography (SS-OCTA) after different approaches in rhegmatogenous retinal detachment. Methods: This was a retrospective study of patients after segmental buckling, circumferential buckling, primary vitrectomy, or combined surgery (vitrectomy and scleral buckling) in whom SS-OCTA was performed at 1 month and 24 months after surgery. Central retinal thickness, central choroidal thickness visual acuity, macula-on vs macula-off status, vascular density, and fovea avascular zones (FAZs) in superficial and deep vascular retinal layers were analyzed. Results: We included 150 eyes of 150 patients. Final visual acuity was better in macula-on vs macula-off cases (P < .05). In comparison with the fellow eyes, final central choroidal thickness was lower in macula-off retinal detachments (P = .042). Deep vessel density was also lower in macula-off eyes when compared with their fellow eyes, which was of high significance in lower quadrants (P = .008). Patients after primary vitrectomy had lower deep FAZ, superficial vessel density, and deep vessel density when compared with eyes after circumferential and segmental buckling (P = .005, P = .037, and P < .001, respectively). After segmental and circumferential buckling, deep vessel density increased between the first and last follow-up visits (P = .018). After primary vitrectomy, no improvements in deep vessel densities after surgery were observed. Macular edema was observed in 13 eyes during the observation period. Multiple variate analysis revealed that the only factor responsible for later occurrence of macular edema was low deep vessel density 1 month after surgery. Conclusion: Segmental buckling does not affect vasculature when visualized with SS-OCTA. Long-term changes observed after circumferential buckling were less pronounced than after primary vitrectomy or combined procedures using perfluorocarbon liquid, silicone oil, and internal limiting membrane peeling. Macula-off patients had a lower postoperative vessel density, correlating with the development of macular edema and decreased final vision.

International consensuses and guidelines on rhegmatogenous retinal detachment (RRD) surgery by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI).

To describe a case series of Coats disease with macular nodule mimicking retinoblastoma. Retrospective case series. Of 339 patients with Coats disease, 7 (2%) with macular nodules were included. All had a referral diagnosis of retinoblastoma. All were males (mean age-6y). The most common presenting complaint was decreased vision (n=4, 57%). Median best corrected visual acuity at presentation was counting fingers close to face, which was maintained at last follow-up (mean, 8 months). The nodule had a mean diameter of 5x4x3mm, was grayish white, and bilobed (n=3, 43%), or dome shaped (n=4, 57%) with surface pigmentation (n=4, 57%), involving fovea (n=5, 71%), with surrounding exudates and second- or third-order retinal vessels. OCT (n=4) showed a well-defined hyperreflective subretinal nodule with posterior shadowing, cysts, and exudates. USG (n=6) showed an echodense intraocular nodule with moderate internal reflectivity with hyperechoic foci in 2 (33%) cases. FFA showed early- and mid-phase hypo-fluorescence with focal leakage with late-phase hyperfluorescence. Focal green laser photocoagulation of the telangiectatic vessels was performed in 5, one underwent subretinal fluid drainage and scleral buckling, and one was observed. Macular nodule in Coats disease represents a preferential accumulation of lipid in the macula. This rare variant of Coats disease can mimic retinoblastoma process. Be aware of this entity to ensure appropriate diagnosis and treatment.

Rhegmatogenous Retinal Detachment in Stickler Syndrome: A Systematic Review and Meta-Analysis.

Purpose:To present results from the Vitreo Retina Society-India (VRSI) 2024 Preference and Trends (PAT) survey focusing on retinal detachment (RD) and myopia management practices among Indian vitreoretinal surgeons.Methods:A 62-item questionnaire was distributed to all VRSI members over email. Responses were collected over 6 weeks by google forms. Data were analyzed using descriptive statistics.Results:A total of 289 members participated in the survey. Prophylactic barrage prerefractive surgery was preferred by 55.21% of the respondents. For phakic retinal detachments, scleral buckling was preferred in the absence of posterior vitreous detachment (PVD) (69.45% single hole, 52% multiple holes), while in pseudophakic, the trend was toward vitrectomy, with an encirclage for inferior breaks (54.38% with no PVD, 52.75% with PVD). For RD with superior breaks with < Grade B PVR, respondents preferred laser to break alone intraoperatively during vitrectomy (65.44%) compared to 360-degree laser and gas tamponade (67.52%), while silicon oil was more preferred tamponade for RD with inferior breaks with > Grade B PVR (99%). Respondents preferred imaging myopic choroidal neovascular membranes with optical coherence tomography and optical coherence tomography angiography (45.42%), initiate treatment with ranibizumab (41.2%), and follow pro-re-nata regimen (61.62%). For myopic macular schisis, vitrectomy was the preferred management for Stage 2C (70%) and Stages 4A and 4C (80%).Conclusions:The VRSI-PAT survey highlights current diverse preferences among Indian vitreoretinal surgeons. These survey results will guide fellow practitioners to understand current real-world practice with relation to established literature.

To report reattachment rate (RR) of pars plana vitrectomy-suprachoroidal viscopexy (VIT-SCVEXY) for rhegmatogenous retinal detachment (RRD) repair. Additionally, this study compares the anatomic reattachment rate and functional outcomes of VIT-SCVEXY vs pars plana vitrectomy with traditional scleral buckle (PPV-SB) at postoperative month 3 and final follow-up. A retrospective cohort study conducted at St. Michael's Hospital, Toronto, Canada, between 2023 and 2024. Consecutive cases of RRD with inferior breaks were included, comparing outcomes between those who underwent VIT-SCVEXY (n = 12) vs PPV-SB (n = 12). Cases were matched for age, gender, lens status, retinal detachment characteristics, preoperative visual acuity, and follow-up duration. A suprachoroidal viscoelastic buckle was successfully created under the break(s) in 75.0% (9/12) of PPV-SCVEXY cases. The reattachment rate at 3 months in those with a successful suprachoroidal buckle was 100% (9/9), with a mean LogMAR BCVA of 0.75 ± 0.25 (Snellen 20/100). The reattachment rate for VIT-SCVEXY and PPV-SB cohorts at 3 months was 100% (12/12). At final follow-up, 88.8% (8/9) of patients who had PPV-SCVEXY remained attached, with an overall retinal reattachment rate of 91.6% (11/12) vs 100% (12/12) in the PPV-SB cohort, p=1.0. Mean LogMAR VA was 0.7±0.5 vs 0.7±0.3 (Snellen 20/100), p=0.9. Chemosis was observed in 25.0% (3/12) of VIT-SCVEXY cases, whereas no adverse events were recorded in PPV-SB cases. VIT-SCVEXY may be a less invasive alternative to PPV-SB with comparable anatomic and functional outcomes. However, further investigations are warranted.

Purpose: To quantify the environmental impact of pars plana vitrectomy (PPV), pneumatic retinopexy, and scleral buckle procedures used in rhegmatogenous retinal detachment (RRD) repair. Methods: We conducted a life cycle assessment of PPV, pneumatic retinopexy, and scleral buckle procedures. The primary outcome measure was the greenhouse gas emissions associated with each procedure measured in carbon dioxide equivalents. Results: The total greenhouse gas emissions produced were 51.10 kg carbon dioxide equivalents for PPV, 2.09 kg carbon dioxide equivalents for pneumatic retinopexy, and 12.57 kg carbon dioxide equivalents for scleral buckle. Emissions related to equipment use (30.07 kg carbon dioxide equivalents) followed by equipment manufacturing (21.00 kg carbon dioxide equivalents) were the main contributors of greenhouse gases in PPV. Emissions related to equipment manufacturing (1.60 kg and 8.51 kg of carbon dioxide equivalents for pneumatic retinopexy and scleral buckle, respectively), followed by equipment use (0.49 kg and 4.05 kg of carbon dioxide equivalents for pneumatic retinopexy and scleral buckle, respectively), were the greatest contributors of greenhouse gases in pneumatic retinopexy and scleral buckle. Conclusions: There is a substantial difference in greenhouse gas emissions among PPV, pneumatic retinopexy, and scleral buckle. Quantifying and understanding these differences can inform surgical decision-making.

Inadvertent Scleral Perforation During Choroidal Melanoma Surgeries: Incidence, Risk Factors, Management, and Outcomes.

Rare extraocular scleral buckle infections caused by microbial species: A case series