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Kelkar AS, Nagpal M, Mondal S, Mehrotra N, Jain H, Sharma A, Camus E, Sathaye V. Chandelier-assisted scleral buckle surgery - contact versus non-contact wide-angle viewing system (CAB-CNV): A retrospective, multicenter, clinical study. Indian J Ophthalmol 2024; 72:1043-1048. [PMID: 38454850 PMCID: PMC11329811 DOI: 10.4103/ijo.ijo_2820_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To investigate and compare the anatomic and functional outcomes of chandelier-assisted scleral buckling (CASB) surgery using contact versus non-contact lens-based wide-angle viewing systems (WAVSs) in rhegmatogenous retinal detachment (RRD) patients. METHODS This was a retrospective, multicenter study evaluating the anatomic (reattachment rate) and visual acuity (VA) outcomes at 6 months post-CASB for primary RRD. RESULTS Forty-seven RRD patients underwent CASB with a non-contact WAVS (Group C1) and 90 with a contact lens WAVS (Group C2). Preoperative parameters including myopia, macula-off RRD, posterior vitreous detachment, number of retinal breaks, and retinal dialysis as the etiology of RRD did not differ significantly between the two groups. The outcomes of retinal attachment (85.11% of C1 patients and 76.67% of C2 patients, P = 0.34) and final visual outcome (VA ≥6/12: C1 = 61.7%; C2 = 46.67%, P = 0.13) were also comparable. Furthermore, no significant difference in postoperative complications such as cataracts, glaucoma, infection, buckle exposure, and buckle failure was observed. Finally, both groups were comparable in terms of re-detachment rates (10.64% in C1 and 23.33% in C2, P = 0.11). CONCLUSION The two WAVS approaches used in CASB surgery have comparable surgical and functional outcomes and postoperative complications. The operating surgeon can freely choose between these viewing platforms during the contemporary scleral bucking (SB) surgery without impacting the outcome.
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Affiliation(s)
- Aditya S Kelkar
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Manish Nagpal
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Sukanya Mondal
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Navneet Mehrotra
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Harsh Jain
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Akansha Sharma
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Erwin Camus
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Vaidehi Sathaye
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
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Takesue A, Yokoyama T, Koiwa C, Mayumi M, Kasuga T. The practical and educational value of scleral buckling with chandelier illumination. Int Ophthalmol 2024; 44:156. [PMID: 38522047 DOI: 10.1007/s10792-024-02940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/16/2023] [Indexed: 03/25/2024]
Abstract
PURPOSE To compare the surgical results in cases of primary rhegmatogenous retinal detachments between standard scleral buckling (SSB) and scleral buckling with chandelier illumination (SBC) and to analyse the differences in SBC surgical results between an experienced ophthalmologist and inexperienced ophthalmologists. METHODS Consecutive surgical case series of 155 eyes that underwent scleral buckling were retrospectively reviewed and divided into four groups: SSB performed by an experienced ophthalmologist (n = 54), SBC performed by an experienced ophthalmologist (n = 52), SBC performed by inexperienced ophthalmologists (n = 40) and SSB performed by inexperienced ophthalmologists (n = 9). Then, these four groups were compared. RESULTS No significant differences were observed between SSB and SBC procedures both performed by the experienced ophthalmologist with regard to demographics, preoperative findings, contents of the surgery, intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SBC performed by the experienced ophthalmologist and SBC performed by the inexperienced ophthalmologists, no significant differences were found regarding intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SSB and SBC procedures both performed by the inexperienced ophthalmologist, a significant difference was found regarding intraoperative complications. CONCLUSION There were no significant differences in surgical results between SSB and SBC when both were performed by the experienced ophthalmologist. In addition, the surgical results were equal between the experienced ophthalmologist and the inexperienced ophthalmologist as far as SBC was concerned. Learning scleral buckling skills by using SBC is a reasonable course of action for inexperienced ophthalmologists.
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Affiliation(s)
- Atsuhide Takesue
- Department of Ophthalmology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.
| | - Toshiyuki Yokoyama
- Department of Ophthalmology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Chihiro Koiwa
- Department of Ophthalmology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Miyako Mayumi
- Department of Ophthalmology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Toshimitsu Kasuga
- Department of Ophthalmology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
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Governatori L, Scampoli A, Culiersi C, Bernardinelli P, Picardi SM, Sarati F, Caporossi T. Chandelier-Assisted Scleral Buckling: A Literature Review. Vision (Basel) 2023; 7:47. [PMID: 37489326 PMCID: PMC10366817 DOI: 10.3390/vision7030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
The treatment of retinal detachment (RD) has seen numerous advancements in the last decades. Scleral buckling (SB) is a surgical procedure introduced in the 1950s that has seen a drastic reduction with the advent of vitrectomy. However, due to the new surgical visualization systems, SB has evolved and continues to be an extremely useful procedure in certain conditions. The presence of different case reports or interventional studies with comparable outcomes, as well as the lack of recent studies with direct comparison, may result in an underestimation of its potential nowadays. The aim of this review is to provide a comprehensive update on chandelier-assisted scleral bucking (CSB), with an overview of the surgical evolution, outcomes, advantages, and complications.
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Affiliation(s)
- Lorenzo Governatori
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Catholic University "Sacro Cuore", 00186 Rome, Italy
| | - Alessandra Scampoli
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Catholic University "Sacro Cuore", 00186 Rome, Italy
| | - Carola Culiersi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University "Sacro Cuore", 00168 Rome, Italy
| | - Patrizio Bernardinelli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University "Sacro Cuore", 00168 Rome, Italy
| | - Stefano Maria Picardi
- Ophthalmology Unit, ASST Melegnano e della Martesana, 20070 Vizzolo Predabissi, Italy
| | - Federica Sarati
- Eye Clinic, Neuromuscular and Sense Organs Department, University of Florence, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health Careggi University Hospital, University of Florence, 50134 Florence, Italy
| | - Tomaso Caporossi
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Catholic University "Sacro Cuore", 00186 Rome, Italy
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Kimura M, Sakanishi Y, Ebihara N. A Case of Lens and Posterior Capsule Injury in Chandelier-Assisted Scleral Buckling for Rhegmatogenous Retinal Detachment. Case Rep Ophthalmol 2023; 14:706-712. [PMID: 38107073 PMCID: PMC10723822 DOI: 10.1159/000535428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Rhegmatogenous retinal detachment (RRD) presents as a common ophthalmological emergency that impacts vision and may lead to blindness in the involved eye. Recently, chandelier-assisted scleral buckling (SB) is considered as one of procedures for the management of RRD. Herein, we present a case of acute cataract progression caused by a chandelier light during chandelier-assisted SB for RRD. Case Presentation A 69-year-old male patient presented with right eye RRD. The best-corrected visual acuity (BCVA) was reduced to 20/40 in the right eye, and a retinal tear was observed at the upper temporal side with macula-off retinal detachment. The retinal tear was on the periphery, and the crystalline lens opacity was mild; therefore, the patient was treated with SB with a chandelier. Intraoperatively, posterior lens opacity was gradually observed, but it did not affect surgery. Thus, the surgery was completed as planned and retinal reattachment was confirmed. The day after surgery, the cataract had progressed, with a significantly decreased right BCVA of 20/400 in the right eye; therefore, cataract surgery was performed 2 months after the initial surgery. Because the posterior capsule had already ruptured, we performed lens extraction and anterior vitrectomy and fixed the intraocular lens with an optic capture. Postoperatively, the patient's BCVA had recovered to 20/40 in the right eye. Conclusion SB with a chandelier is an effective treatment for visibility and educational purposes; however, several points of caution are raised. Proper care should be taken while handling the illumination in the SB.
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Affiliation(s)
- Meiko Kimura
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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Ilhan C, Citirik M, Dulger SC, Ozdemir M. Long-term Complications of Conventional and Chandelier-Assisted Scleral Buckle for Primary Repair of Rhegmatogenous Retinal Detachment. J Curr Ophthalmol 2022; 34:323-327. [PMID: 36644470 PMCID: PMC9832457 DOI: 10.4103/joco.joco_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the outcomes of conventional indirect ophthalmoscopy and wide-angled visualization with chandelier endo-illumination methods in scleral buckle surgery by focusing on postoperative complications in the postoperative long-term period. Methods In this retrospective comparative study, patients who underwent scleral buckle surgery due to rhegmatogenous retinal detachment were included in the study. Conventional scleral buckle surgery using indirect ophthalmoscopy was performed in Group 1, and wide-angled visualization with chandelier endo-illumination method in scleral buckle surgery was performed in Group 2. The outcomes of the two methods were compared. Results The demographic and baseline clinical characteristics of the groups were similar (P > 0.05, for all). The mean follow-up time was 70.47 ± 20.32 weeks (52-116) in Group 1 and 64.89 ± 18.12 weeks (52-100) in Group 2 (P > 0.05). There was no significant difference in the mean postoperative best-corrected visual acuity and redetachment rates of the groups (P > 0.05, for both). The cumulative rate of postoperative complications was more frequent in Group 1 (P = 0.011) despite being not significant in one-by-one comparison of the complications including epiretinal membrane, proliferative vitreoretinopathy, glaucoma, cystoid macular edema, foveal atrophy, gaze restriction, and macular hole (P > 0.05, for all). Conclusion Using wide-angled visualization with chandelier endo-illumination in scleral buckle surgery, favorable surgical outcomes can be achieved in the postoperative long-term period with fewer complications.
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Affiliation(s)
- Cagri Ilhan
- Department of Ophthalmology, Hatay Mustafa Kemal University, Tayfur Ata Sokmen Medicine Faculty, Hatay, Turkey,Address for correspondence: Cagri Ilhan, Ekinci Mah., Cevreyolu Cad., Royals Park 13/1 No: 23, Antakya, Turkey. E-mail:
| | - Mehmet Citirik
- Department of Ophthalmology, University of Health Sciences, Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Selda Celik Dulger
- Department of Ophthalmology, University of Health Sciences, Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Mesut Ozdemir
- Department of Ophthalmology, University of Health Sciences, Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Chandelier-Assisted versus Standard Scleral Buckling for Primary Rhegmatogenous Retinal Detachment: A Randomized Clinical Study. Retina 2022; 42:1745-1755. [PMID: 35507948 DOI: 10.1097/iae.0000000000003519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare anatomical outcomes, functional outcomes, and rate of complications of standard (SSB) versus chandelier-assisted scleral buckling (CSB) in phakic eyes with rhegmatogenous retinal detachment (RRD). Methods: Patients were randomly assigned to either SSB or CSB. Surgical success/failure rate, corrected distance visual acuity (CDVA), surgical operating time, rate of intraoperative and postoperative complications including epiretinal membranes (ERM) by spectral-domain optical coherence tomography (SD-OCT) were compared between groups. Results: A total of 50 eyes of 49 patients were included. At 6 months, there was no statistically significant difference between groups in primary success, or final anatomical success (P > 0.9); mean CDVA at any visit (P values >0.05); or mean surgical time: 120.3±39.05 and 102.48±43.76 minutes for the SSB and CSB, respectively (P = 0.1). The CSB had a higher rate of postoperative complications (34.8%) compared to the SSB (3.8%) (P < 0.05). On SD-OCT, CSB had a statistically significant higher rate of ERMs compared to SSB (44% versus 18% (P < 0.05)) and showed vitreous entrapment in the chandelier sclerotomy site on the UBM. Conclusion: CSB do not offer encouraging advantages over SSB. On the contrary, we detected a higher rate of complications with CSB especially ERMs development.
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Six-Year Outcomes of 25-Gauge Chandelier Illumination-Assisted Scleral Buckling. BIOMED RESEARCH INTERNATIONAL 2022; 2021:4628160. [PMID: 35402605 PMCID: PMC8986389 DOI: 10.1155/2021/4628160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022]
Abstract
Objectives To report the long-term results of scleral buckling using 25-gauge chandelier illumination. Methods The medical records of all patients presenting to Shanghai Tenth People's Hospital with simple rhegmatogenous retinal detachment (RRD) from June 2013 to Oct 2015 were retrospectively reviewed in this consecutive case series. All patients underwent preoperative and postoperative best corrected visual acuity (BCVA), B-ultrasound, fundus photography, and optical coherence tomography examination. Ultrasound biomicroscopy (UBM) was obtained postoperatively. Results Ten patients (10 eyes) were included in the final analysis. Of 10 patients, the average age was 49.3 ± 18.9 years old, the average duration of RRD was 30.9 ± 53.3 days, and the mean follow-up period was 6.2 ± 0.9 years. There were nine eyes with myopia and four eyes with macular detachment. The primary anatomical success rate was 90%. Five eyes underwent 360-degree band with element surgery, and five eyes underwent element surgery alone. The average length of encircling band and element was 68.2 ± 1.3 mm and 10.5 ± 2.5 mm, respectively. There were no intraoperative or postoperative complications that occurred. The final BCVA was greater than or equal to 20/40 in nine eyes, of which four eyes achieved 20/20. UBM examination of the 25-gauge chandelier insertion site revealed no tissue proliferation. Conclusions For simple rhegmatogenous retinal detachment treatment, 25-gauge chandelier illumination-assisted scleral buckling is a kind of effective and safe method.
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Al Abdulsalm O, Al Habboubi H, Mura M, Al-Abdullah A. Re-Vitrectomy versus Combined Re-Vitrectomy with Scleral Buckling for Pediatric Recurrent Retinal Detachment. Clin Ophthalmol 2022; 16:877-884. [PMID: 35345825 PMCID: PMC8957344 DOI: 10.2147/opth.s356993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare re-vitrectomy versus combined re-vitrectomy with scleral buckling (SB) for pediatric recurrent rhegmatogenous retinal detachment (RRD) following failed primary pars plana vitrectomy (PPV). Methods This was a retrospective, comparative case series of pediatric patients (under 18 years) who underwent secondary RRD procedures after failed primary PPV. Patients were divided into the re-vitrectomy and the combined re-vitrectomy with SB groups. The primary outcome was the anatomical success rate for each procedure. The secondary outcomes were changes in best-corrected visual acuity (BCVA) and postoperative complications. Results In the re-vitrectomy group (30 eyes), the final anatomical success rate was 83.3% (25/30) after a mean follow-up of 21.7 + 6.9 months. The final anatomical success rate in the combined re-vitrectomy/SB group (23 eyes) was 73.9% (17/23) after a mean follow-up of 26.5 + 7.7 months. There was no statistically significant difference in the final anatomical success rate (P = 0.41) and the mean change in BCVA (P = 0.37) between the two groups. Even though not statistically significant, the combined re-vitrectomy/SB group had a lower incidence of postoperative complications (P = 0.25). Conclusion Re-vitrectomy alone provides similar anatomical and functional outcomes to combined re-vitrectomy/SB for pediatric recurrent RRD after failed primary PPV.
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Affiliation(s)
- Omar Al Abdulsalm
- Ophthalmology Division, King Abdulaziz Hospital (Ministry of National Guard Health Affairs), King Abdullah International Medical Research Center (KAIMRC), Al Ahsa, Saudi Arabia
| | - Hussain Al Habboubi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Ophthalmology Division, Prince Mohammed Bin Abdulaziz Hospital, Medina, Saudi Arabia
| | - Marco Mura
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulelah Al-Abdullah
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Ophthalmology Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Nam KY, Lim HB, Kim MS, Kim JY. Twenty-seven-gauge endoilluminator-assisted scleral buckling using a wide-field viewing system: Case report. Medicine (Baltimore) 2021; 100:e27206. [PMID: 34664854 PMCID: PMC8447986 DOI: 10.1097/md.0000000000027206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE We report a new scleral buckling technique using a 27-gauge endoilluminator and a wide-field viewing system to overcome the limitations of conventional indirect ophthalmoscope-methods and "chandelier-assisted" surgery. PATIENT CONCERNS A 26-year-old female patient visited the local clinic for floaters and lower visual field defects in her left eye that had occurred 5 days prior. DIAGNOSES On fundus examination, upper retinal detachment without macular involvement and an atrophic hole was observed in her left eye. INTERVENTIONS Under general anesthesia and after perilimbal conjunctival incision, extraocular muscle isolation, and traction with black silk, a 27-gauge trocar-cannula was inserted 90° away from the retinal break, 4 mm away from the limbus. Under wide-field viewing using a contact lens, the fundus was observed through a surgical microscope. Retinal break was evaluated and cryopexy was performed with careful movement of the endoilluminator, paying attention to damage to the lens. The surgeon could accurately and freely control the direction of the illumination tip to obtain a brighter view of the region of interest. OUTCOMES There were no complications associated with trocar cannula incision or the illuminator. The retina was successfully reattached. LESSONS Twenty seven gauge endoilluminator-assisted scleral buckling is an easy and safe procedure and provides better control over and free adjustment of the light direction, thus overcoming the limitations of chandelier-assisted surgery.
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Affiliation(s)
- Ki Yup Nam
- Department of Ophthalmology, Chungnam National University Sejong Hospital, South Korea
- Department of Ophthalmology, Chungnam National University, College of Medicine, South Korea
| | - Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University Hospital, South Korea
| | - Min Su Kim
- Department of Ophthalmology, Chungnam National University Hospital, South Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, Chungnam National University Hospital, South Korea
- Department of Ophthalmology, Chungnam National University, College of Medicine, South Korea
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A PILOT CLINICAL STUDY OF TREATING RHEGMATOGENOUS RETINAL DETACHMENT BY SILICONE RUBBER BALLOON SCLERAL BUCKLING. Retina 2021; 40:1918-1928. [PMID: 31725525 PMCID: PMC7505152 DOI: 10.1097/iae.0000000000002685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Hong IH, Jeon GS, Han JR. Comparison of Scleral Buckling and Vitrectomy Using Wide Angle Viewing System for Rhegmatogenous Retinal Detachment. Semin Ophthalmol 2020; 35:307-312. [DOI: 10.1080/08820538.2020.1842468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
| | - Gang Seok Jeon
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Korea
| | - Jae Ryong Han
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
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Mafi M, Mirghorbani M, Ghahvehchian H, Mohammadi SS, Riazi-Esfahani H, Khalili Pour E, Mahmoudi A, Khojasteh H, Modjtahedi BS. Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy. Ophthalmol Ther 2020; 9:641-651. [PMID: 32666396 PMCID: PMC7406596 DOI: 10.1007/s40123-020-00279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Mostafa Mafi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mahmoudi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.,Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA.,Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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Eibenberger K, Sacu S, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E, Georgopoulos M. Clinical characteristics and surgical outcome of pediatric and early adulthood retinal detachment. Eur J Ophthalmol 2020; 31:1367-1374. [PMID: 32192354 DOI: 10.1177/1120672120913030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the underlying pathologies, demographic and retinal detachment characteristics in pediatric and early adulthood retinal detachment. METHODS Patients with rhegmatogenous, serous, or tractional retinal detachment aged 0-26 years were retrospectively reviewed. The preschool group (n = 4) comprised children aged 0-6 years, the pediatric group (n = 19) comprised children aged 7-16 years, and the early adulthood group (n = 13) aged 17-26 years. Demographic information and retinal detachment characteristics, type of surgery, and intraocular tamponade were analyzed. Postoperatively, the functional outcome, anatomic success, and ocular adverse events were evaluated. Due to the low patient number in the preschool group, statistical analysis was performed for pediatric group and early adulthood group only. RESULTS All causes of retinal detachment were present in the pediatric group, but only rhegmatogenous retinal detachment in the early adulthood group. In both groups, the main type of surgical intervention was pars plana vitrectomy (pediatric group: 52%, early adulthood group: 38%; p = 0.36). The type of intraocular tamponade varied statistically significantly between the groups (p = 0.014). Silicone oil was the main intraocular tamponade in the pediatric group (48%), whereas no tamponade (54%) followed by gas tamponade (46%) in the early adulthood group. Final attachment rate was similar in both groups (pediatric group: 89%, early adulthood group: 100%; p = 0.35). Re-detachment occurred significantly sooner in the pediatric group (1.3 ± 0.3 months) than in the early adulthood group (4.3 ± 1.4 months; p = 0.03). CONCLUSION In pediatric and early adulthood retinal detachment, pars plana vitrectomy appeared as a successful surgical intervention. Re-attachment rate and re-treatment were similar in both groups with a better functional outcome observed in cases of retinal detachment in early adulthood and poorer results in young children.
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Affiliation(s)
| | - Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | | | - Eva Stifter
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
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SCLERAL BUCKLING FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT USING A NONCONTACT WIDE-ANGLE VIEWING SYSTEM WITH A CANNULA-BASED 27-G CHANDELIER ENDOILLUMINATOR. Retina 2019; 39 Suppl 1:S144-S150. [DOI: 10.1097/iae.0000000000001891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kita M, Kusaka M, Yamada H, Hama S. Updated chandelier illumination-assisted scleral buckling using 3D visualization system. Clin Ophthalmol 2019; 13:1743-1748. [PMID: 31564825 PMCID: PMC6735622 DOI: 10.2147/opth.s218975] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the updated chandelier illumination-assisted scleral buckle procedures using a 3D visualization system. SUBJECTS AND METHODS We report a single-center, retrospective, consecutive surgical case series of 18 eyes of 16 patients that underwent scleral buckle procedures combining the use of chandelier endoillumination, a noncontact wide-angle viewing system, an anti-drying contact lens, and a recently developed 3D visualization system. The mean age of the patients was 30.2 years, and the mean follow-up time was 11.3 months. RESULTS Retinal reattachment was achieved after the first surgery in all cases. There were no cases that required conversion of the 3D visualization to a conventional microscopic view. This updated chandelier-assisted scleral buckle procedure was successfully performed without any intraoperative or postoperative complications, except for the occurrence of postoperative diplopia in one case in which a supplementary radial buckle was used for a deep tear. CONCLUSION The updated chandelier illumination-assisted scleral buckling surgery using a 3D visualization system appears to be a valuable and promising method for managing rhegmatogenous retinal detachment due to atrophic holes in lattice degeneration or ciliary tears in younger cases.
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Affiliation(s)
- Mihori Kita
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Mami Kusaka
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Yamada
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Sachiyo Hama
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
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Frisina R, Forlini M, Date P, Meduri A, Pinackatt JS, Sborgia L, Besozzi G, Parolini B. Microscope-Assisted ab externo Surgery for the Treatment of Primary Rhegmatogenous Retinal Detachment - New Tech Meets Old Art. Ophthalmic Res 2019; 63:34-40. [PMID: 31352453 DOI: 10.1159/000501213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
AIM To report the outcomes of ab externo surgery using a surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted ab externo surgery) for rhegmatogenous retinal detachment (RRD). METHODS This was a retrospective study. Consecutive charts of patients with RRD who underwent microscope-assisted ab externo surgery were analyzed. The following demographic parameters were analyzed: age (years), gender (male/female), and eye (right/left). Clinical parameters were axial length (AL) measured in millimeters (mm), preoperative best-corrected visual acuity (BCVA) measured in logarithm of minimum angle of resolution (logMAR), intraocular pressure (IOP), and lens status (phakic/pseudophakic). The parameters of RRD were number and type of retinal breaks, location of retinal breaks, extent of retinal detachment (RD) (number of detached quadrants), and macular detachment (MD), as well as retinal breaks not detected preoperatively. Use of cryopexy, circumferential or segmental scleral buckle, drainage of subretinal fluid, injection of air or gas, and duration of surgery were recorded. The postoperative parameters analyzed were BCVA, IOP and recurrence of RD and postoperative complications. Follow-up was established at 3 months. RESULTS A total of 213 eyes (97 right, 116 left) of 205 patients (114 males, 91 females) affected by primary RRD were included. Fifty-two eyes (24.4%) were affected by high myopia (AL >26.5 mm), and 160 patients (75.1%) were affected by RRD caused by a single retinal break and involving only one quadrant. The superior quadrant was the most frequently involved (49.3%). Forty-two eyes (19.7%) were affected by MD. In 13 eyes (11.3%), retinal breaks were not detected preoperatively. The duration of surgery was 75.5 ± 42 min. No significant BCVA changes were observed in the whole group, whereas a significant improvement of BCVA from the baseline (2.83 ± 0.87 logMAR) to each time point of follow-up was observed in the subgroup of patients affected by MD. Six eyes (2.8%) developed a recurrent RD, secondary to proliferative vitreoretinopathy (3 eyes) and secondary to a new retinal break (3 eyes). Two eyes developed a persistent vitreous hemorrhage, and one eye developed a macular hole after 1 week. PPV was performed for both. CONCLUSION Microscope-assisted ab externo surgery is effective and safe, it reduces discomfort, it allows the surgeon to work with both hands free, and provides an adequate visualization of each step being performed.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Padova, Italy,
| | | | | | | | | | - Luigi Sborgia
- Institute of Ophthalmology, University of Bari, Bari, Italy
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Jeon GS, Han J. Effectiveness of Scleral Buckling with a Wide-Field Surgical Microscope and Chandelier Illumination in Retinal Detachment Repair. Ophthalmologica 2019; 242:31-37. [DOI: 10.1159/000496165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022]
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Ishikawa K, Kohno RI, Hasegawa E, Nakao S, Yoshida S, Sonoda KH. Preoperative estimation of distance between retinal break and limbus with wide-field fundus imaging: Potential clinical utility for conventional scleral buckling. PLoS One 2019; 14:e0212284. [PMID: 30753247 PMCID: PMC6372206 DOI: 10.1371/journal.pone.0212284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Accurate scleral marking of retinal breaks is essential for successful scleral buckling. This study aimed to investigate the use of wide-field fundus images obtained with an Optos for preoperative estimation of the distance from the limbus to the retinal breaks. METHODS AND ANALYSIS This is a retrospective review of 29 eyes from 26 patients with rhegmatogenous retinal detachment who received scleral buckling with anatomically successful repair. They underwent wide-field fundus photography with Optos California. In the pre- and postoperative fundus images, we measured distances from the macula to the retinal tears (TM), to the center of the vortex veins (VM), to the optic disc (DM), and to the posterior edge of the scleral buckle (BM). RESULTS (BM-VM) / DM was significantly correlated with the distance from the limbus to the posterior edge of the scleral buckle that had been determined intraoperatively. (r = 0.705; p<0.001) We applied a regression line derived from this correlation with the value of (TM -VM) / DM in order to calculate estimated distances between retinal breaks and the limbus. The calculated distances were all within the range of distances from the limbus to the anterior and posterior edges of the scleral buckles. CONCLUSION Preoperative analysis of Optos images may be useful for estimating the distance from the limbus to retinal breaks, which might aid scleral marking during scleral buckling surgery.
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Affiliation(s)
- Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Ri-ichiro Kohno
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiichi Hasegawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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McElnea E, Stephenson K, Gilmore S, O'Keefe M, Keegan D. Paediatric retinal detachment: aetiology, characteristics and outcomes. Int J Ophthalmol 2018; 11:262-266. [PMID: 29487817 DOI: 10.18240/ijo.2018.02.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023] Open
Abstract
AIM To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. METHODS A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. RESULTS Twenty-eight eyes of 24 patients, 15 (62.5%) of whom were male and 9 (37.5%) of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6%) cases which underwent surgical repair the retina was attached at last follow-up. CONCLUSION Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.
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Affiliation(s)
- Elizabeth McElnea
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Kirk Stephenson
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sarah Gilmore
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Michael O'Keefe
- Department of Ophthalmology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - David Keegan
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,Department of Ophthalmology, Temple Street Children's University Hospital, Dublin 1, Ireland
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Jo J, Moon BG, Lee JY. Scleral Buckling Using a Non-contact Wide-Angle Viewing System with a 25-Gauge Chandelier Endoilluminator. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:533-537. [PMID: 29230977 PMCID: PMC5726988 DOI: 10.3341/kjo.2017.0044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/22/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator. Methods Retrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination. Results The patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached. Conclusions Scleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.
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Affiliation(s)
- Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Gil Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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21
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Sakono T, Otsuka H, Shiihara H, Yoshihara N, Sakamoto T. Acute bacterial endophthalmitis after scleral buckling surgery with chandelier endoillumination. Am J Ophthalmol Case Rep 2017; 8:7-10. [PMID: 29260106 PMCID: PMC5731552 DOI: 10.1016/j.ajoc.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The non-contact wide-angle viewing system (WAVS) with chandelier endoillumination is being used more commonly during scleral buckling surgery for rhegmatogenous retinal detachments although its safety has not been established. We report our findings in a case of bacterial endophthalmitis that developed after scleral buckling surgery with WAVS and chandelier endoillumination. Observations A 42-year-old man underwent scleral buckling surgery for a rhegmatogenous retinal detachment in his right eye using a WAVS with chandelier endoillumination. Three days after the surgery, the patient noticed a marked decrease in his vision with ocular pain. Slit-lamp examination showed dense infiltration in the anterior chamber and vitreous body. Pars plana vitrectomy with antibiotic irrigation was done immediately, and Staphylococcus epidermidis was detected in the vitreous fluid. After vancomycin 6/day for 4 weeks, the inflammation gradually subsided, and the visual acuity recovered to 20/20 in 3 months. Conclusions and importance Acute bacterial endophthalmitis can develop after scleral buckling surgery performed with WAVS and chandelier endoillumination.
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Affiliation(s)
- Takato Sakono
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroki Otsuka
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideki Shiihara
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoya Yoshihara
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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A Review of Innovations in Rhegmatogenous Retinal Detachment Surgical Techniques. J Ophthalmol 2017; 2017:4310643. [PMID: 28584664 PMCID: PMC5444028 DOI: 10.1155/2017/4310643] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 12/21/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) requires surgical intervention for its repair. There are variable techniques used for this purpose, and they are all being continuously refined. In this review, we detail the recent innovations in surgical management of RRD and proliferative vitreoretinopathy (PVR).
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Scleral buckling with a noncontact wide-angle viewing system in the management of rhegmatogenous retinal detachment. Eur J Ophthalmol 2017; 27:98-103. [PMID: 27312205 DOI: 10.5301/ejo.5000819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce a modified scleral buckling surgery using noncontact wide-angle viewing system and intraocular illumination in the treatment of rhegmatogenous retinal detachment (RRD) without proliferative retinopathy. METHODS A modified scleral buckling surgery using noncontact wide-angle viewing system with a 25-G optic fiber through sclerotomy site was performed in 22 eyes of 22 patients with RRD. Twelve women and 10 men were included. The mean age was 49.23 ± 15.19 years. The mean refraction of myopia was -4 D (range -3 to -7 D). The mean duration of RRD was 6.64 ± 3.14 days. The preoperative best-corrected visual acuity (BCVA) ranged from 0.02 to 0.8. Mean follow-up was 9.59 ± 2.24 months. Proliferative retinopathy was grade A in 8 eyes and grade B in 14 eyes. RESULTS This surgery was performed successfully and retinal attachment was achieved in all eyes at the final follow-up. The postoperative BCVA increased in all eyes. No complication was encountered related to this technique. CONCLUSIONS This modified scleral buckling surgery brings a panoramic and upright view and easy surgical maneuvers. It may be an additional approach for the management of RRD.
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Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure. J Ophthalmol 2017; 2017:4671305. [PMID: 29333292 PMCID: PMC5733179 DOI: 10.1155/2017/4671305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the outcome of sutureless encirlcing number 41 band and transscleral laser retinopexy in uncomplicated rhegmatogenous retinal detachment (RRD), using a wide-angle viewing system (WAVS) and chandelier endoillumination. Methods Prospective intervention study included 30 eyes of 30 patients presenting with RRD of recent onset indicated for SB. All cases were treated by sutureless encircling number 41 band and transscleral laser retinopexy. Visualization was provided by the Resight WAVS and a single 27-gauge chandelier endoillumination. Anatomical and visual outcomes were evaluated. Results The mean age of our group was 49.8 ± 12.3 years, and the mean duration of RD was 7 (0–50) days. Twenty-four eyes (80.0%) were phakic while the remaining 6 eyes (20%) were either pseudophakic or aphakic. The primary retinal reattachment rate was 83.3% (25 out of 30 eyes). LogMAR visual acuity improved from 1.3 (0.30–2.0) preoperatively to 1.0 (0.40–1.60) at first month (p = 0.002) and to 0.70 (0.20–1.92) at third month (p < 0.001). Conclusion Sutureless encircling number 41 band with chandelier-assisted transscleral laser retinopexy is a safe and effective technique for managing uncomplicated RRD. It provides a high primary success rate while eliminating the complications of cryotherapy, sutures, and broad buckles.
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Temkar S, Takkar B, Azad SV, Venkatesh P. Endoillumination (chandelier) assisted scleral buckling for a complex case of retinal detachment. Indian J Ophthalmol 2016; 64:845-846. [PMID: 27958210 PMCID: PMC5200989 DOI: 10.4103/0301-4738.195603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Endoilluminator-assisted scleral buckling combines the advantages of scleral buckling for its external approach and pars plana vitrectomy for its better visual visualization in the management of retinal detachment (RD). It has recently been proven to be safe and efficacious in simple cases. This report discusses successful management of a complex case of RD in a patient with the single functioning eye, where vitrectomy was expected to have a complicated course.
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Affiliation(s)
- Shreyas Temkar
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Vardhan Azad
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Li XJ, Yang XP, Lyu XB. Comparison of scleral buckling using wide-angle viewing systems and indirect ophthalmoscope for rhegmatogenous retinal detachment. Int J Ophthalmol 2016; 9:1310-4. [PMID: 27672597 DOI: 10.18240/ijo.2016.09.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the effects of scleral buckling using wide-angle viewing systems (WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment. METHODS The study was a retrospective analyses of the medical records of 94 eyes (94 patients) with rhegmatogenous retinal detachment. Among them, 47 eyes underwent scleral buckling using WAVS with endoilluminator (Group W), and 47 eyes underwent scleral buckling using indirect ophthalmoscope (Group I). Surgical durations, primary success rate, best-corrected visual acuities (BCVA), delayed subretinal fluid absorptions and surgical complications were compared between the two groups. RESULTS At baseline, there were no statistical differences between the two groups in patient's age (P=0.997), gender (P=0.853), symptom duration (P=0.216), BCVA (P=0.389), refractive error (P=0.167), intraocular pressure (P=0.595), the number of retinal breaks (P=0.832), the extent of retinal detachment (P=0.246), subretinal demarcation line (P=0.801), and macular detachment (P=0.811). The follow-up period was 12mo. The surgical durations in Group W (with or without encircling buckling) were significant shorter than those in Group I (P<0.001 respectively). The primary success rate was 94.27% in Group W, which was similar to that in Group I (92.38%, P = 0.931). The BCVA in Group W was better than that in Group I (P<0.001) at 1-month follow-up visit. However, there were no significant differences between the two groups at 3-month (P=0.221), 6-month (P=0.674), and 12-month (P=0.363) follow-up visits respectively. Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month (P=0.045) follow-up visit, but there were no significant differences between the two groups at 3-month (P=0.111), 6-month (P=1.000) and 12-month follow-up visits respectively. CONCLUSION Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment.
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Affiliation(s)
- Xiu-Juan Li
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xiao-Peng Yang
- Department of Medical Equipment, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xiao-Bei Lyu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Seider MI, Nomides REK, Hahn P, Mruthyunjaya P, Mahmoud TH. Scleral Buckling with Chandelier Illumination. J Ophthalmic Vis Res 2016; 11:304-9. [PMID: 27621789 PMCID: PMC5000534 DOI: 10.4103/2008-322x.188402] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.
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Affiliation(s)
| | | | - Paul Hahn
- Duke University Eye Center, Durham, NC, USA
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Chandelier-Assisted External Subretinal Fluid Drainage in Primary Scleral Buckling for Treatment of Rhegmatogenous Retinal Detachment. Retina 2015; 36:203-5. [PMID: 26618804 DOI: 10.1097/iae.0000000000000820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gurler B, Coskun E, Öner V, Comez A, Erbagci I. Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment. Int Ophthalmol 2015; 36:521-5. [PMID: 26627689 DOI: 10.1007/s10792-015-0158-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.
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Affiliation(s)
- Bulent Gurler
- Department of Ophthalmology, Fatih University Medicine School, Istanbul, Turkey
| | - Erol Coskun
- Department of Ophthalmology, Gaziantep University Medicine School, Gaziantep, Turkey
| | - Veysi Öner
- Department of Ophthalmology, Recep Tayyip Erdogan University Medical School, Rize, Turkey.
| | - Aysegul Comez
- Department of Ophthalmology, Sutcu Imam Universtiy Medicine School, Kahramanmaras, Turkey
| | - Ibrahim Erbagci
- Department of Ophthalmology, Gaziantep University Medicine School, Gaziantep, Turkey
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