Scleral Buckle: Does it Still Have a Role in Retinal Detachment Repair?

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

Importance The scleral buckle technique is difficult to teach, given a decrease in the frequency of its use and the challenges of its video recording.

Background This study compares two different modalities for recording intraoperative videos of scleral buckle surgery.

Design Present study is a cross-sectional survey conducted in an academic hospital.

Participants A total of 36 medical students, ophthalmologic residents, and vitreoretinal surgery fellows participated in this survey.

Methods Five scleral buckle surgeries were filmed simultaneously using Google Glass and GoPro. Single-masked survey of trainees comparing video and audio quality of 38 10-second clips from each device, and listing the steps of scleral buckle surgery. Institutional review board approval and informed consent were obtained.

Main Outcome Measures Trainees were asked for grading the video device with respect to audio and video quality as favorable or unfavorable.

Results GoPro clips had more favorable ratings of video (73.3%) and audio (75.9%), compared with Google Glass (36.7 and 58.5%, respectively; p < 0.005). A total of 2.8% respondents listed the correct order of surgical steps in pretest, compared with 55.6% in posttest (p < 0.005).

Conclusion and Relevance Wearable recording devices can allow for video recording of scleral buckle surgery which has high utility in teaching trainees. GoPro and Google Glass each have distinct advantages.

Segmental scleral buckling without sling sutures around the muscles

PURPOSE

To introduce a modified technique for segmental buckling through a small in situ conjunctival opening without rectus muscle traction for minimally invasive repair of uncomplicated rhegmatogenous retinal detachment.

METHODS

This technique was performed in 15 eyes of 15 selected patients with primary retinal detachment. Conventional traction sutures placed beneath rectus muscles were replaced by an absorbable translimbal traction suture at lesion quadrant. The conjunctival incision was made 8-9 mm posterior and parallel to the limbus. After cryopexy, a minimal explant was fixed with one to two sutures through the conjunctival opening, expanded by a pediatric speculum.

RESULTS

Retinal reattachments were achieved with correct buckle positions in all patients, with rapid cosmetic recovery.

CONCLUSION

This modified buckling technique simplifies the buckling procedure, minimizes surgical invasiveness, preserves intact limbal conjunctiva, and relieves discomfort.

Postoperative Complications of Scleral Buckling

Scleral buckling has an important role in the repair of certain categories of rhegmatogenous retinal detachments. These include detachments in young phakic patients, detachments associated with dialysis, and also in conjuction with vitrectomy in patients who have sustained trauma or have developed proliferative vitreoretinopathy. However, it can be associated with significant postoperative complications. The most important ones are refractive change, intrusion or extrusion, infection, globe ischemia, and choroidal detachments, amongst others. Careful planning, appropriate patient selection, and good intraoperative technique can reduce the rate of these complications.

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.

Catheter-guided suprachoroidal buckling of rhegmatogenous retinal detachments secondary to peripheral retinal breaks

PURPOSE

To evaluate functional and anatomic outcomes of eyes undergoing suprachoroidal buckling (SCB) using a specially designed catheter for the management of rhegmatogenous retinal detachment (RRD) secondary to peripheral retinal breaks.

METHODS

Retrospective cohort study of 62 eyes of 62 patients. Subjects underwent SCB for the management of RRD secondary to single or multiple retinal breaks. Suprachoroidal indentation was achieved through the introduction of viscoelastic material in the suprachoroidal space overlying the break using an illuminated, 450 μm-wide, flex-tip catheter. This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition. Forty-seven eyes (80 %) underwent SCB alone, while 15 eyes (20 %) were combined with 25-G pars-plana vitrectomy. Cryopexy and laserpexy were used in 38 (61 %) and 24 of eyes (39 %) respectively.

RESULTS

Mean pre-operative best-corrected visual acuity (BCVA) improved from logMAR 0.82 (20/132) to 0.22 (20/33) (p < 0.0001). The single surgery reattachment rate was 92 % (57/62.) Final retinal reattachment was achieved in all eyes (100 %). No significant difference was observed in single-surgery anatomic success rates when stratified by lens status, macular involvement, or break location. There were no major intra- or post-operative complications.

CONCLUSION

Suprachoroidal buckling using a special-design, flexible catheter is a safe and effective procedure for the management of RRD secondary to peripheral retinal breaks.