Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective

PURPOSE

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes.

METHODS

We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed.

RESULTS

Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR ( P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis.

CONCLUSION

Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Changes in retinal nerve fiber layer and vessel densities after scleral buckling in patients with rhegmatogenous retinal detachment observed by OCTA

Purpose

To observe the changes in peripapillary retinal nerve fiber layer (RNFL) thickness and peripapillary vessel densities (VD) in patients with rhegmatogenous retinal detachment (RRD) after scleral buckling (SB) by OCTA.

Methods

A total of 40 patients (40 eyes) with monocular RRD who underwent SB were included in the study, with the operated eyes (40 eyes) as the study group and the contralateral healthy eyes (40 eyes) as the control to analyse the changes in peripapillary RNFL thickness and VD before and after surgery. Data were analysed by paired samples t-test or Wilcoxon signed rank sum test.

Results

Comparison of the peripapillary RNFL thickness in the 8 areas between the two groups during the 6-month follow-up period: All 8 peripapillary areas of the optic disc were statistically different before surgery, except for the tempo superior and tempo inferior, which were statistically different at each postoperative follow-up point, and the remaining 6 areas in the operated eyes group were progressively closer to those in the healthy eyes group, and there was no significant difference between the two groups. Comparison of peripapillary VD in the 8 areas between the two groups during the 6-month follow-up: Peripapillary VD in the 8 areas in the two groups were all statistically different before surgery, and except for superior tempo, which was statistically different at each postoperative follow-up time point, the remaining seven areas in the operated eyes group became progressively closer to that in the healthy eyes group and there was no significant difference.

Conclusion

RRD negatively affects the peripapillary RNFL, but both peripapillary RNFL thickness and VD gradually improved in the operated eyes close to the contralateral eyes after SB.

Morphologic Features of Regulated vs. Dysregulated Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography

OBJECTIVE

To describe varying morphological features of patients with RRD based on the extent of regulation of the subretinal space by the retinal pigment epithelium (RPE) pump using swept-source optical coherence tomography (SS-OCT).

DESIGN

Prospective clinical cohort study.

METHODS

 Setting: St. Michael's Hospital, Toronto, Canada, from August 2020-August 2023.

PARTICIPANTS

120 consecutive eyes with primary RRD. Cohorts: Subclinical, non-progressive, localized RRD defined as regulated vs. acute, progressive, and extensive defined as dysregulated, assessed with SS-OCT.

MAIN OUTCOME

Morphological features of regulated vs. dysregulated RRDs with SS-OCT.

RESULTS

19.2% (23/120) of RRDs were classified as regulated and 80.8% (97/120) were dysregulated. The mean age of patients with regulated RRDs was 37.1 years (±13.7 SD) vs. 62.6 years (±11.6SD) for patients with dysregulated RRDs (P < .001). The presence of outer retinal corrugations (ORCs) on OCT was observed in 4.3% (1/23) of regulated vs. 81.4% (79/97) of dysregulated RRDs (P < .001). CME was found in 41.6% (5/12) of regulated RRDs compared to 87.3% (83/95) of dysregulated RRDs (P < .001). ORC presence was an independent predictor of having a dysregulated RRD (P = .02, β = 6.6, 95% CI [1.3-33.2]) when controlling for age, sex, baseline VA, lens status, and RD extent. Among patients with regulated RRDs, 25.0% (3/12) were in Stage 2, 0% (0/16) in Stage 3A, 8.3% (1/12) in Stage 3B, 0% (0/16) in Stage 4, and 66.7% (8/12) in Stage 5. In patients with dysregulated RRDs, 14.7% (14/95) were in Stage 2, 15.7% (15/95) were in Stage 3A, 37.9% (36/95) in Stage 3B, 22.1% (21/95) in Stage 4, and 9.5% (9/95) in Stage 5 (P < .001).

CONCLUSIONS

There are significant morphologic differences between regulated and dysregulated RRDs using SS-OCT. ORCs are present in almost all dysregulated cases but in a minority of regulated cases and they are an independent predictor of RPE-photoreceptor regulation status. Demographic and clinical features differentiate regulated and dysregulated RRD and understanding these differences has significant implications for optimal management and postoperative outcomes.

The Usefulness of 55° Wide-Field Spectral-Domain Optical Coherence Tomography in Monitoring the Features of Peripheral Subretinal Fluid Remnants after Rhegmatogenous Retinal Detachment Surgery

BACKGROUND

This study aimed to assess the effectiveness of 55° wide-field (WF) spectral-domain (SD) optical coherence tomography (OCT) for detecting peripheral subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment (RRD).

METHODS

In this retrospective observational study, the retinal periphery was examined to evaluate the possible presence of persistent SRF after surgery. OCT scans were acquired in infrared mode to use any peripheral vessel as a landmark for better repeatability in monitoring fluid remnants.

RESULTS

A total of 80 patients (10% with high myopia) were examined using 55° WF SD OCT after successful pars plana vitrectomy (83.8%) or scleral buckling (16.3%) for RRD. A total of 18 patients (22.5%), 16 of whom underwent pars plana vitrectomy and 2 who underwent scleral buckling, showed SRF at the OCT examination during the follow-up. Potential risk factors associated with SRF persistence were analyzed, revealing a significative association with young age (p = 0.009). After a follow-up period of 7.05 ± 2.44 months (ranging from 3 to 12 months), a complete resorption in all patients (100%) within 12 months was observed. Best-corrected visual acuity significantly improved in both groups over time.

CONCLUSION

Using 55° WF SD-OCT successfully assessed the course of SRF reabsorption, offering a viable alternative for all those realities where technologies such as ultra-wide-field (UWF) OCT are not available.

Cataract Outcomes Following Scleral Buckle Surgery for Retinal Detachment

Purpose

To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD).

Patients and methods

A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted.

Results

Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes.

Conclusion

Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

BACKGROUND

Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.

RESULTS

A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).

CONCLUSION

PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series

BACKGROUND

Macular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD.

METHODS

Clinical records of patients undergoing SB surgery for treatment of RRD at the Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed.

RESULTS

Among 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients.

CONCLUSIONS

Patients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Surgical Outcomes of Rhegmatogenous Retinal Detachment and Fellow Eye Involvement in Adolescent and Young Adult Patients

PURPOSE

To investigate the associations, fellow eye retinal tear or detachment, and surgical outcomes of rhegmatogenous retinal detachments (RRDs) in young adults.

DESIGN

Retrospective consecutive case series.

SUBJECTS

Patients aged ≤ 30 years who underwent surgical repair for RRD between 2014 and 2021 at a single practice. The mean age was 23.85 years (range, 12-30 years).

METHODS

Data collected included demographics, preoperative clinical features of the RRD, visual acuity (VA), type of surgery performed, anatomic outcomes, OCT findings, fellow eye retinal tear or detachment, and postoperative complications.

MAIN OUTCOME MEASURES

Postoperative VA and single-surgery anatomic success rate.

RESULTS

One hundred one patients (109 eyes) were included. Sixty-seven patients (74 eyes) and 17 patients (19 eyes) were followed for ≥ 1 year and 5 years, respectively. The most common associations were myopia (66 eyes, 60.6%), trauma (8 eyes, 7.3%), and prior ocular surgery (7 eyes, 6.4%). Median preoperative Snellen VA was 20/70. The macula was attached in 31 eyes. Scleral buckle (SB) alone was performed in 75 eyes, pars plana vitrectomy (PPV) + SB was performed in 27 eyes, PPV alone was performed in 6 eyes, and cryotherapy with pneumatic retinopexy was performed in 1 patient. Single-surgery anatomical success was 88.7% for SB, 89.7% for PPV + SB, and 75% for PPV. The median final postoperative Snellen VA was 20/50. Twelve patients presented with bilateral RRDs, and sequential surgery was performed in 8 patients, followed by 4 patients who underwent surgery with fellow eye laser barricade. Fourteen patients (13.9%) developed a retinal tear or detachment in the fellow eye, with a mean interval of 8 months from presentation. Of the 17 patients who were followed for ≥ 5 years, 3 patients (17.6%) developed a fellow eye retinal tear or detachment. After initial anatomical success, 6 eyes (5.5%) developed proliferative vitreoretinopathy.

CONCLUSIONS

The most common association of RRD in this study was myopia. Scleral buckle alone was the most common surgical intervention. However, outcomes were generally favorable with SB-only and PPV + SB. Surgeons and patients should be aware of the risk of bilateral retinal detachment and the risk of fellow eye retinal tear and detachment. These patients require long-term surveillance in both eyes.

FINANCIAL DISCLOSURE(S)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Effect of external subretinal fluid drainage on persistent subretinal fluid after scleral buckle surgery in macula-involving rhegmatogenous retinal detachment

This study aimed to analyze the duration and causes of persistent subretinal fluid (PSF) after scleral buckle (SB) surgery in patients with macula-involving rhegmatogenous retinal detachment (RRD). Sixty-one eyes of 61 patients with macula-involving RRD who underwent SB surgery between 2016 and 2022 were reviewed retrospectively. PSF was confirmed on optical coherence tomography. The PSF duration after surgery and the analysis of relevant ocular and systemic factors were conducted according to the PSF duration. The mean duration of PSF was 5.9 ± 4.6 months in all eyes and 8.1 ± 5.0 months in eyes not treated with external subretinal fluid (SRF) drainage, which was significantly longer than 4.5 ± 3.7 months in those subjected to external SRF drainage. The mean best-corrected visual acuity improved significantly 3 months after surgery. There were significant visual improvements in the external SRF drainage group compared to the non-drainage group during all follow-up periods. Longstanding shallow RRD was significantly associated with longer PSF duration after SB surgery. External SRF drainage during SB surgery can effectively reduce SRF, shorten the duration of PSF, and accelerate visual improvement.

COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey

BACKGROUND

To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic.

METHODS

An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022.

RESULTS

To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation.

CONCLUSIONS

SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.

Surgical decisions and outcomes of rhegmatogenous retinal detachment during the coronavirus disease 2019 pandemic: Data from a tertiary referral center in Taiwan

Purpose

To assess changes in surgical decisions and outcomes of rhegmatogenous retinal detachment (RRD) during the COVID-19 pandemic at a tertiary center in Taiwan.

Methods

Patients undergoing pars plana vitrectomy (PPV) or scleral buckling (SB) for primary RRD during Taiwan's first wave of domestic COVID-19 cases surge between May and July 2021 (COVID cohort, n = 100) were compared to controls in the closest pre-COVID year, 2019 (pre-COVID cohort, n = 121).

Results

The COVID cohort had significantly worse RRD presentation, received more PPV (alone or combined with SB (PPV + SB)) and less SB alone, and had comparable single-surgery anatomic success (SSAS) rates. In patients who underwent PPV, more underwent PPV + SB instead of PPV alone. The decision to combine SB in PPV surgery was significantly affected by the COVID pandemic (odds ratio [OR], 3.1860 [95% confidence interval (CI), 1.1487-8.8361]). However, a shorter duration of symptoms before the first presentation (0.9857 [95% CI, 0.9720-0.9997]) was the only factor related to SSAS, whereas the surgical method had no association. The SSAS rate remained close to or over 90% in patients with a duration of symptoms before surgery ≤4 weeks but dropped to 83.3% in patients with duration >4 weeks.

Conclusion

During the COVID-19 pandemic, worse RRD presentations led to a shift in preference for PPV over SB alone as the primary surgery. The pandemic affected surgeons' decision to combine SB during PPV. Nevertheless, SSAS was only associated with the duration of symptoms but not with surgical methods.

A pilot clinical study of complex rhegmatogenous retinal detachment treatment via foldable capsular buckle scleral buckling

BACKGROUND

To evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling.

METHODS

This prospective clinical study enrolled five patients with complex rhegmatogenous retinal detachment treated with foldable capsular buckle scleral buckling at the 988th Hospital of People's Liberation Army Joint Logistic Force, China. During the 24-week follow-up period, the patients underwent measurements of their best-corrected visual acuity, slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Additionally, B-ultrasound and fundus photography of the patients' retinal reattachments helped evaluate the treatment's post-surgery efficacy. We determined the safety of foldable capsular buckle scleral buckling based on infection, eye pain, diplopia, elevated intraocular pressure, and other postoperative severe complications.

RESULTS

All five patients' complex rhegmatogenous retinal detachments were successfully treated and evaluated via B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in four patients 24 weeks after surgery, while the remaining patients developed diplopia after surgery. No other complications were observed.

CONCLUSION

This pilot study preliminarily determined that foldable capsular buckle scleral buckling is feasible for efficient and safe treatment of complex rhegmatogenous retinal detachment. These results support this surgery as a potential and novel alternative to current extraocular procedures for treating complex rhegmatogenous retinal detachment.

TRIAL REGISTRATION

The prospective observational clinical study protocol was approved by the Institutional Review Board and Ethics Committee and registered at the clinical research center in the 988th Hospital of People's Liberation Army Joint Logistic Force, China (9,882,019,000).

Retinal surgery quality indicators for uncomplicated primary rhegmatogenous retinal detachment without a national registry

PURPOSE

The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres.

METHODS

In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re-detachment and/or serious postoperative complication would be reported back.

RESULTS

The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis.

CONCLUSION

Our hypothesis that data in the surgical department's medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals.

Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment

BACKGROUND/OBJECTIVES

The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade.

SUBJECTS/METHODS

The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed.

RESULTS

48 patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6 and 100% vs 100%, all P values > 0.05). Postoperative best-corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2 ± 0.4 vs 2.6 ± 0.5, P < 0.001 and 0.1 ± 0.4 vs 0.4±0.9, P = 0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02).

CONCLUSIONS

Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.

Effect of High Myopia on Delayed Absorption of Subretinal Fluid after Scleral Buckling Surgery

This study compared the absorption of subretinal fluid (SRF) in patients with rhegmatogenous retinal detachment (RRD) with and without high myopia after scleral buckling (SB) and investigated the effect of high myopia on SRF absorption. This retrospective study included patients with primary macula-off RRD grouped according to myopia and age. The optical coherence tomography (OCT) and OCT angiography indicators included subretinal fluid height (SRFH), subfoveal choroidal thickness (SFCT), and choroidal capillary blood flow density (CCFD) measured regularly. The presence of SRF 3 months after surgery was defined as delayed absorption. Overall, 90 eyes of 89 patients were enrolled, and 46 eyes (51.11%) had high myopia. In 43 eyes (47.78%), SRF absorption was delayed. There was no significant difference in SRF absorption after SB between the high and non-high myopia groups; younger patients (<35 years) had a higher probability of delayed absorption (p < 0.05). The SFCT in high myopia was significantly thinner than that in the non-high myopia group (p < 0.05); SFCT and SRFH were positively correlated (rs = 0.275, p = 0.002), and there was a significant difference between the average CCFD with and without SRF (p < 0.05). High myopia had no significant effect on SRF absorption after SB.

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7212 Eyes

PURPOSE

The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB+PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear.

METHODS

A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB+PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated.

RESULTS

Across 18 studies, 3912 SB and 3300 SB+PPV eyes were included. Final BCVA was non-significantly different between SB and SB+PPV (20/38 vs. 20/66 Snellen; WMD=-0.11 LogMAR; 95%CI [-0.29,0.07]; P=0.23). Primary reattachment rate was similar between procedures (P=0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR=1.03; 95%CI [1.00,1.06]; P=0.04). Compared to SB+PPV, SB alone had a significantly lower risk of postoperative macular edema (RR=0.69; 95%CI [0.47,1.00]; P=0.05) and cataract formation (RR=0.34; 95%CI [0.12,0.96]; P=0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB+PPV.

CONCLUSIONS

There was no significant difference in final BCVA between SB+PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.

Outcomes of primary rhegmatogenous retinal detachment repair among young adult patients

PURPOSE

To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults.

METHODS

A retrospective, comparative case series study. Patients between the ages of 18 and 40 years who underwent surgical repair of primary RRD between the years 2006 and 2013 were included. Patients were divided into three groups according to the surgical technique used: scleral buckle (SB), pars plana vitrectomy (PPV) or combined surgery (SB-PPV).

RESULTS

Ninety eyes (90 patients) were included. The mean age (SD) was 31.5 ± 5.1 years (range 22-40). Sixty-seven patients underwent SB, 10 had PPV and 13 had SB-PPV. Anatomical success rates were similar between the three groups (87%, 90% and 85% for SB, PPV and SB-PPV groups, respectively; p-value = 0.9). Mean (SD) preoperative LogMAR visual acuity (VA) was 0.46 ± 0.6, 1.73 ± 1.1, 1.1 ± 1.1 for SB, PPV and SB-PPV groups, respectively (p < 0.0001). The VA improved at last follow-up to 0.23 ± 0.4, 0.7 ± 1.5 and 1.09 ± 1.08 in SB, PPV and SB-PPV groups, respectively (p < 0.0001). Macula-off was diagnosed in 19.4% of SB, 80% of PPV and 53.9% of SB-PPV groups (p < 0.0001). In the SB group one phakic patient (1.5%) needed cataract extraction, while following PPV, all phakic eyes (100%) underwent cataract extraction eventually (p-value < 0.0001).

CONCLUSIONS

The study emphasizes the efficacy of SB as a primary procedure for the repair of retinal detachment in young adults in terms of anatomical and functional success. Furthermore, preservation of the lens as a result of using SB rather than PPV when possible is of great importance in this age group.

Scleral Buckle versus Pars Plana Vitrectomy in the Management of Primary Chronic Rhegmatogenous Retinal Detachment: A Comparison of Anatomical and Visual Outcomes

PURPOSE:

The purpose of this study is to compare the anatomical and visual outcomes of scleral buckle (SB) surgery with the pars plana vitrectomy (PPV) in the management of chronic rhegmatogenous retinal detachment.

METHODS:

This cohort study included patients who underwent surgical repair SB group and PPV group for chronic retinal detachment during 2014–2018 at the King Khalid Eye Specialist Hospital, Riyadh. The anatomical and functional success rate at 12 months after surgery was compared in two groups. Cox regression and linear regression analysis were performed to identify the predictor of anatomical and functional outcomes, respectively. Need for second surgery was also evaluated.

RESULTS:

Our cohort had 68 eyes in SB and 64 eyes in PPV group. Eyes that underwent PPV were more likely to develop retinal detachment over 12 months than those that underwent SB surgery (adjusted heart rates 2.11, 95% confidence interval [CI], 0.95–4.64 P = 0.065). A multivariable linear regression analysis did not reveal a significant association between the surgery type and change in visual acuity (beta coefficient, 0.002; 95% CI,−0.184, 0.189 for specific bread volume; P = 0.979). A higher percentage of eyes in the PPV group compared with those in the SB surgery group required secondary surgery (39.1% vs. 22.1%; P = 0.034).

CONCLUSION:

Scleral buckling surgery showed a better single surgery anatomic success rate as compared to PPV in the management of chronic primary rhegmatogenous retinal detachment. The functional outcome of the two procedures was comparable.

UTILIZATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO IDENTIFY POSTERIOR VITREOUS DETACHMENT IN PATIENTS WITH RETINAL DETACHMENT

PURPOSE

To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD).

METHODS

Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography-identified PVD with PVD identified on slit-lamp biomicroscopy.

RESULTS

There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD.

CONCLUSION

Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.

Vitreous function and intervention of it with vitrectomy and other modalities

The vitreous body, the largest intraocular component, plays a key role in eye development, refraction, cell barrier function, oxygen metabolism and the pathogenesis of assorted diseases. Age, refraction and systemic diseases can cause vitreous metabolic abnormalities. With the continuous development of vitrectomy techniques and equipment, vitreous injections and vitrectomies have increased over the recent decades. However, the normal oxygen tension gradient in the vitreous helps to protect the lens and anterior chamber angle from oxidative stress damage, whereas the increased vitreous oxygen tension around lens and the trabecular meshwork after vitrectomy may lead to postoperative nuclear cataract and a high incidence of open angle glaucoma. As a conventional procedure, scleral buckling holds several advantages over vitrectomy in selected cases. This review raises concerns regarding the function of the vitreous, and encourages conducting vitreous interventions prudently.

The impact of the COVID-19 Pandemic on rhegmatogenous retinal detachment treatment patterns

Backgrounds

To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 Pandemic.

Methods

A retrospective cohort of RRD patients was analyzed. Patients were divided into the COVID-19 pandemic group and pre-COVID-19 group according to their presentation. The presurgery characteristics, surgical procedures, and surgery outcomes were collected. The potential factors related to the choice of pars plana vitrectomy (PPV) or scleral buckling (SB) were analyzed using logistic regression. The differences in the procedure choice under specific conditions were compared. Surgery outcomes were compared between the two groups.

Results

In the COVID-19 pandemic group, less patients received SB (27.8, 41.3%, p = 0.02) while more patients received PPV (72.2, 58.6%, p = 0.02); in patients who received SB, fewer patients received subretinal fluid drainage (45.4,75.7%, p = 0.01); in patients who received PPV, fewer patients received phacovitrectomy (7.0, 21.0%, p = 0.02). The choice of PPV was related to older age (1.03, p = 0.005), the presence of RRD with choroidal detachment (RRD-CD) (2.92, p = 0.03), pseudophakia (5.0, p = 0.002), retinal breaks located posterior to the equator (4.87, p < 0.001), macular holes (9.76, p = 0.005), and a presurgery visual acuity (VA) less than 0.02 (0.44, p = 0.03). Fewer phakia patients with retinal breaks located posterior to the equator (1/28, 11/30, p = 0.01) and fewer patients with chronic RRD and subretinal strand (1/9, 9/16, p = 0.03) received SB in the COVID-19 pandemic group. There were more patients with improved VA (55.7, 40.2%, p = 0.03) in the COVID-19 pandemic group. The overall single-surgery retinal attachment rate was similar in the two groups (94.9, 94.5%, p = 0.99).

Conclusions

During the COVID-19 Pandemic, the main reason for the increased number of PPV in RRD treatment was that more complicated cases were presented. However, the surgeons were conservative in procedure choice in specific cases. The adjustments on RRD treatments lead to comparable surgery outcomes.

A PILOT CLINICAL STUDY OF TREATING RHEGMATOGENOUS RETINAL DETACHMENT BY SILICONE RUBBER BALLOON SCLERAL BUCKLING

PURPOSE

To evaluate the efficacy and primary safety of treating rhegmatogenous retinal detachment (RRD) using foldable capsular vitreous body scleral buckling.

METHODS

Five patients with simple RRD were treated with foldable capsular vitreous body scleral buckling. B-ultrasound and fundus photography examining of retina reattachment were used to evaluate the postsurgery efficacy. The safety of the treatment was evaluated based on the occurrence of infection, eye pain, diplopia, elevated intraocular pressure, and other serious postoperative complications after surgery. The observation time after the operation was at least 12 weeks.

RESULTS

The simple RRD of all five patients was successfully reattached before being evaluating by B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in two patients who were macularly affected. One patient had temporary diplopia and eye movement limitation after surgery. No other complications were recorded.

CONCLUSION

This pilot study determined that foldable capsular vitreous body scleral buckling can be efficacious and safe for simple RRD. The results indicate that this surgery may be a novel alternative to the current extraocular procedures for simple RRD.

The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services-Experiences from the Tongren eye center in Beijing

Purpose

To investigate the impact on services for rhegmatogenous retinal detachment (RRD) patients during the COVID-19 (2019coronal virus disease) pandemic in one tertiary center in Beijing.

Methods

A retrospective cohort study. Two reviewed consecutive RRD patients cohorts of the same length were treated during two different periods: the COVID-19 pandemic and the pre-COVID-19 group. The characteristics of patients, surgery, anesthesia methods, length of hospital stay, and the latest follow-up were recorded and analyzed.

Results

There were 79 patients in the COVID-19 pandemic group with a 55.9% reduction (179). Compared to patients in the pre-COVID-19, patients in the COVID-19 pandemic had a longer presurgical waiting times (28days, 3days, p<0.001), a higher percentage of patients with presurgical poor (less than 0.02) visual acuity (55.7%, 32.4%, p = 0.009), and a higher percentage of patients with presurgical choroidal detachment (34.2%, 19.6%, p = 0.01). There was no significant difference in the severity of presurgical proliferative vitreoretinopathy between the two groups (p = 0.64). Surgeries on pathological myopia patients with macular hole retinal detachment were postponed in the COVID-19 pandemic. There was a lower percentage of scleral buckling (27.8%, 41.3%, p = 0.02) and a lower rate of subretinal fluid drainage (45.4%, 75.7%, p = 0.01) in the COVID-19 pandemic. There was no significant difference in either postoperative visual acuity (p = 0.73) or the rate of single-surgery retinal attachment (p = 1) between the two groups. Patients in the COVID-19 pandemic had a shorter length of hospital stay (3hours, 35 hours, p<0.001), and a lower percentage of patients received general anesthesia (48.1%, 83.2%, p<0.001). None was infected with COVID-19 disease during the pandemic.

Conclusion

The COVID-19 pandemic lockdown caused prolonged presurgical waiting times, shorter hospital stays, less general anesthesia, and a significant reduction of RRD surgeries. The RD were more complicated, the surgeons were more conservative on procedures and patients selection, while the surgery outcomes were comparable.

Impact of air injection on subretinal fluid following successful scleral buckling surgery for macular-involving retinal detachment

Air injection is an accessory technique during scleral buckling (SB). Subclinical subretinal fluid (SRF) may presence and persistent after SB. The impact of air injection on SRF is unclear. In the study, we retrospectively enrolled 51 patients with macular-involving RD who had undergone successful SB. They were categorized into Group A (SB without air injection) and Group B (SB with air injection). First, we found that although group B seem to be severer than group A before surgery, Kaplan–Meier graph showed that SRF absorbed more rapidly in group B after surgery, and the incidence of SRF in group B was much lower during the whole follow-up period. Moreover, the cases with superior breaks had the lowest incidence. Second, during the follow-up period, there was no significant difference about postoperative complication between two groups. Lastly, risk factors for persistent SRF were investigated with binary logistic regression, and no risk factor was found. In conclusion, air injection during the SB might accelerate SRF absorption and reduce the incidence of persistent SRF, especially for the longstanding macular-off RD with superior breaks.

Multifactor analysis of delayed absorption of subretinal fluid after scleral buckling surgery

Background

The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal detachment (RRD). We also examined related factors that may affect the delayed absorption of SRF.

Methods

This retrospective study included patients who underwent successful SB surgery for the treatment of macula-off RRD and in which the retina was reattached after the surgery. The patients were categorized according to gender, duration, age, the number, and location of retinal breaks. Subfoveal choroidal thickness (SFCT), height of subretinal fluid (SRFH), and the choriocapillaris flow density (CCFD) within 3 × 3 mm macular fovea were included. Delayed absorption was determined by the SRF that remained unabsorbed for 3 months after the procedure. The endpoint was determined when the SRF could no longer be observed.

Results

A total of 62 patients (63 eyes) were enrolled. In 35 eyes (56.45%) SRF was completely absorbed and in 28 (43.55%) eyes delayed absorption of SRF in macular areas was observed at 3 months after surgery. A young age (< 35 years), inferior retinal breaks were associated with good outcomes by applying multivariable analysis on the rate of SRF absorption after SB instead of gender, the number of breaks, and duration (p < 0.05). CCFD was significantly different between the SRF group and the non-SRF group after SB (0.66 ± 0.04% vs 0.63 ± 0.05%, P < 0.05). SRFH showed a moderate positive correlation with SFCT (r_s = 0.462, p = 0.000), however, using binary logistic regression analysis it was determined that SFCT was not related to the absorption of the SRF.

Conclusions

The absorption of SRF after SB may be correlated with choriocapillaris flow density. Age and location of breaks are significant factors affecting the absorption of SRF. The duration of disease is an uncertain factor due to several subjective reasons.

Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment

PURPOSE

To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD).

METHODS

This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration.

RESULTS

The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients.

CONCLUSION

Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.

Pneumatic retinopexy: A critical reappraisal

Pneumatic retinopexy (PR) has been widely advocated for treatment of selected rhegmatogenous retinal detachments: those with small, anterior, superior, retinal breaks and little or no proliferative vitreoretinopathy. It has been suggested that PR is underused and is advantageous because it is an outpatient clinic or office procedure, short in duration, nonincisional, and cost saving - with reduced perioperative morbidity, faster postoperative recovery, better and faster visual recovery, a low rate of complications and a high rate of overall success compared with scleral buckling or pars plana vitrectomy. We reevaluated these advantages to substantiate the effectiveness and efficiency of PR and critically define its role in the treatment of rhegmatogenous retinal detachment. We found that PR has a much higher rate of subsequent reoperation and proliferative vitreoretinopathy than scleral buckling or pars plana vitrectomy for simple, good prognosis rhegmatogenous retinal detachments. PR often involves multiple procedures that largely negates its potential cost savings and subjects the patient to prolonged stress and disability. Scleral buckling rather than PR is ideally suited for simple, good prognosis rhegmatogenous retinal detachments for surgeons who feel comfortable with the technique; alternatively, pars plana vitrectomy is indicated.

Choroidal vascular changes after encircling scleral buckling for rhegmatogenous retinal detachment

BACKGROUND/OBJECTIVES

There is an ongoing debate on whether encircling scleral buckling (SB) procedure for the treatment of rhegmatogenous retinal detachment (RRD) may cause an impairment in choroidal blood flow. The aim of this study was to compare choroidal vascularity index (CVI) and subfoveal choroidal thickness (CT) between eyes that had undergone encircling SB with unoperated fellow eyes (FEs).

SUBJECTS/METHODS

Thirty patients treated with encircling SB for unilateral RRD were included. Demographic and clinical characteristics as well as enhanced depth imaging-optical coherence tomography scans were retrospectively collected. Images were binarised using ImageJ software, total choroidal area along with luminal and stromal area (respectively, TCA, LA and SA) were segmented and the CVI was computed as the ratio of LA/TCA. In addition, CT was evaluated.

RESULTS

The mean follow-up interval between surgery and examination was 25.5 ± 16.8 months. Choroidal thickness, TCA, LA and SA were significantly increased in the operated eyes compared to FEs (respectively, 271.7 ± 78.0 µm vs. 238.5 ± 83.4, P = 0.001; 1.804 ± 0.491 mm² vs. 1.616 ± 0.496, P = 0.001; 1.199 ± 0.333 mm² vs. 1.067 ± 0.337, P < 0.001 and 0.605 ± 0.171 mm² vs. 0.550 ± 0.171, P = 0.001). Conversely, CVI did not significantly differ between the two groups (66.4 ± 3.6 vs. 65.9 ± 3.2, P = 0.490).

CONCLUSIONS

In conclusion, eyes treated with encircling SB for RRD presented increased LA, SA and CT compared with FEs, but showed no difference in CVI.

Corneal Biomechanical Response Alteration After Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

PURPOSE

To compare the corneal biomechanics of eyes that underwent scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) with those of fellow eyes (fellow eyes) and to further investigate the effects of SB on intraocular pressure (IOP) values.

DESIGN

Retrospective, fellow-eye matched cohort study.

METHODS

A total of 18 consecutive patients (11 males and 7 females) treated with SB for RRD in 1 eye were enrolled. Goldmann applanation tonometry was used to measure IOP. Biomechanical properties of the cornea were investigated by using the Ocular Response Analyzer (ORA) (Reichert Instruments) for the calculation of corneal resistant factor (CRF), corneal hysteresis, Goldmann-correlated IOP, and corneal-compensated IOP. Customized software was used for analysis of the ORA infrared and pressure signals, and a significance threshold was set to a P value of .05.

RESULTS

Operated eyes (OEs) showed significantly lower values of corneal hysteresis and CRF than fellow eyes (9.0 ± 1.8 vs 10.1 ± 1.8 mm Hg, respectively; P < .001; 10.0 ± 2.2 vs 10.9 ± 2.2 mm Hg; P < .001). GAT was significantly lower than corneal-compensated IOP in OEs (18.1 ± 4.9 vs 19.8 ± 4.8 mm Hg, respectively; P = .022) but not in fellow eyes. The second applanation event (A2) took place earlier in time, and the cornea was moving faster during A2 in the OEs than in the fellow eyes.

CONCLUSIONS

SB for the treatment of RRD affects corneal biomechanical response, likely due to a less compliant sclera that limits corneal motion and reduces energy dissipation, reflected in a lower corneal hysteresis. This has potentially meaningful clinical implications as the accuracy of the measurement of IOP values may be affected in these eyes.

Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy

Introduction

Scleral buckling (SB) tends to be more challenging and time-consuming for compared to the pars plana vitrectomy for repairing rhegmatogenous retinal detachments (RRDs). This study characterizes a novel and simplified technique for SB.

Methods

In this single-masked randomized interventional study, patients with RRDs who were eligible for SB were randomly assigned to either the standard (S) or modified (M) technique of SB. In the modified approach, neither intraoperative break localization nor cryopexy or subretinal fluid drainage was done. A large tire (276/279) was placed where preoperative retinal breaks had been localized with a 240 encircling band placed for support of the remaining retina. Patients were followed for 12 months and the primary outcomes were differences between the surgical groups in operative time, anatomical success, visual acuity, and complication rate.

Results

Thirty-six eyes were included in the study (18 in each arm). There were no differences in baseline patient demographics or characteristics including gender, age, lens and macular status, preoperative vision, and symptom duration. The mean length of surgery was 72.2 ± 13.2 and 56.2 ± 9.5 min in groups S and M, respectively (P = 0.001). Complete retinal reattachment at the end of month 12 after single surgery was 80.6% overall; 77.8% (14/18) in group S and 83.3% (15/18) in group M (P > 0.999). After 12 months, both groups achieved similar final best-corrected visual acuity (BCVA): 0.26 ± 0.23 and 0.23 ± 0.17 logMAR in groups S and M, respectively (P = 0.231). Controlling for preoperative BCVA on ANCOVA testing, there were no significant differences in visual improvement between the two groups [F (1,26) = 0.02, P = 0.966 (95% CI) − 0.128 to 0.123)]. Scleral perforation (2:1), vitreous hemorrhage (3:2), and transient rise of intraocular pressure (3:4) all occurred at a low and similar rate between the two groups (S:M).

Conclusion

Modified SB technique was non-inferior compared to the standard approach for anatomical and visual outcomes. Shortening surgical time while maintaining low complication rates makes this an appropriate approach to SB, especially for vitreoretinal surgery trainees.

Electronic supplementary material

The online version of this article (10.1007/s40123-020-00279-1) contains supplementary material, which is available to authorized users.

Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment

Purpose

To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base in vitrectomy for rhegmatogenous retinal detachment (RRD).

Patients and methods

This was a retrospective study of patients who underwent vitrectomy for RRD without proliferative vitreoretinopathy. Barrier laser was applied as 3-4 rows surrounding the break at the end of fluid-air exchange. For the FBL, 3-4 rows of laser burn were additionally made about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base. The primary outcome was single surgery success rate (SSSR) between two groups: FBL and conventional barrier laser (CBL) groups.

Results

Overall, 118 eyes were included; 50 eyes in the FBL group and 68 eyes in the CBL group. SSSR was 100% (50/50) in the FBL group and 91.2% (62/68) in the CBL group with a significant difference (p=0.038). Four eyes of the recurrent cases in the CBL group were related to reopening of the break. All eyes achieved reattachment, and no differences were found in postoperative visual acuity at 6 months.

Conclusion

FBL on the vitreous base was efficacious in improving the anatomical success rate of vitrectomy.

Scleral structure and biomechanics

As the eye's main load-bearing connective tissue, the sclera is centrally important to vision. In addition to cooperatively maintaining refractive status with the cornea, the sclera must also provide stable mechanical support to vulnerable internal ocular structures such as the retina and optic nerve head. Moreover, it must achieve this under complex, dynamic loading conditions imposed by eye movements and fluid pressures. Recent years have seen significant advances in our knowledge of scleral biomechanics, its modulation with ageing and disease, and their relationship to the hierarchical structure of the collagen-rich scleral extracellular matrix (ECM) and its resident cells. This review focuses on notable recent structural and biomechanical studies, setting their findings in the context of the wider scleral literature. It reviews recent progress in the development of scattering and bioimaging methods to resolve scleral ECM structure at multiple scales. In vivo and ex vivo experimental methods to characterise scleral biomechanics are explored, along with computational techniques that combine structural and biomechanical data to simulate ocular behaviour and extract tissue material properties. Studies into alterations of scleral structure and biomechanics in myopia and glaucoma are presented, and their results reconciled with associated findings on changes in the ageing eye. Finally, new developments in scleral surgery and emerging minimally invasive therapies are highlighted that could offer new hope in the fight against escalating scleral-related vision disorder worldwide.

Surgical outcomes of Pars Plana Vitrectomy for recurrent retinal detachment in eyes previously treated with Pars Plana Vitrectomy or Scleral Buckling

PURPOSE

To report anatomical and functional outcomes of pars plana vitrectomy (PPV) for recurrent retinal detachment (RD) after failed scleral buckling (SB) or primary PPV.

METHODS

Retrospective analysis of 59 eyes with recurrent RD treated previously with SB or PPV was performed. All eyes underwent 23 gauge PPV. The primary outcome was single surgery success rate (SSSR) for retinal reattachment at the final visit. Secondary outcomes were visual acuity change and number of reoperations.

RESULTS

SSSR was 77.4 % in the SB group and 67.9 % in the PPV group (P=0.41). The mean change in visual acuity was not significantly different between the two groups (P=0.35). The mean number of reoperations was 1.2±0.5 and 1.4±0.6 in the SB and PPV groups, respectively (P=0.38).

CONCLUSION

PPV was found to be an effective technique for the management of recurrent RD after SB and PPV surgeries. However, the small sample size and the retrospective design prevent any claims of advantages or disadvantages of one surgical technique over the other.

Wide-angled endoillumination vs traditional scleral buckling surgery for retinal detachment - a comparative study

Purpose

To evaluate the surgical outcomes of traditional scleral buckling (TSB) compared to chandelier-assisted scleral buckling (CSB) for rhegmatogenous retinal detachment repair.

Patients and methods

A retrospective interventional comparative case series of 49 eyes that underwent SB procedure. Medical records of 27 and 22 eyes that underwent TSB and CSB surgery, respectively, were evaluated. Outcome measures included primary anatomical success, visual acuity (VA), and perioperative complications.

Results

Primary reattachment rate was similar with 85.2% in the TCB group and 81.8% in the CSB group (P=1.00); eight patients needed one additional operation or gas injection with a final reattachment rate of 100% at 6 months. Mean VA in the CSB group improved from 20/60 at presentation to 20/35, 6 months postoperatively. In the TSB group, VA improved from 20/80 to 20/45 (P=0.90). Among the eyes that were successfully reattached with either SB approach, two eyes in each group had cataract progression and none of them required surgery during follow-up. No cases of endophthalmitis were observed.

Conclusion

CSB is a modified technique with an advantage of superior visualization compared with the traditional surgery, which simplifies the operation, enhance competency, and could be used as a valuable educational tool. It can provide similar anatomical and functional outcomes with no additional perioperative complications.