scholarly journals Scleral Buckling: A Review of Clinical Aspects and Current Concepts

2022 ◽  
Vol 11 (2) ◽  
pp. 314
Author(s):  
Matteo Fallico ◽  
Pietro Alosi ◽  
Michele Reibaldi ◽  
Antonio Longo ◽  
Vincenza Bonfiglio ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Functional Results ◽  
Scleral Buckling ◽  
Clinical Aspects ◽  
Indirect Ophthalmoscopy ◽  
Retinal Breaks ◽  
Valuable Treatment ◽  
Type Of Surgery ◽  
Phakic Eyes

Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.

Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV

2020 ◽  
pp. bjophthalmol-2020-315945
Author(s):  
Takayuki Baba ◽  
Ryo Kawasaki ◽  
Keita Yamakiri ◽  
Takashi Koto ◽  
Koichi Nishitsuka ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Cataract Surgery ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Study Data ◽  
Giant Retinal Tear ◽  
Retinal Breaks ◽  
Surgical Methods ◽  
Pars Plana ◽  
Registry Report

Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis was a prospective, nationwide, multicentre, observational study. Data from the Japanese Retina and Vitreous Society registry from 2016 to 2017 were used to determine the association between preoperative clinical factors, surgical procedures and postoperative BCVA at 6 months. Japanese individuals >40 years of age were included. Eyes with proliferative vitreoretinopathy were included. The primary outcome was the percentage of eyes that achieved 20/25 vision.ResultsOf the 3219 registered cases, 2192 met the inclusion criteria (344 SB, 1738 PPV, 110 PPV+SB). Cases with preoperative BCVA (≤0 logarithm of the minimum angle of resolution (logMAR) units) had good postoperative BCVA (OR=3.97, CI 2.87 to 5.51). Older age (>70 years), low intraocular pressure (<10 mm Hg), high myopia (<−5 dioptres), multiple retinal breaks (>4), giant retinal tear (>90°), wide retinal detachment (>3 quadrants) and macula-off detachment were associated with less probability of postoperative 20/25 vision (OR=0.39, 0.64, 0.62, 0.60, 0.12, 0.51 and 0.36, respectively). Postoperative BCVA was 0.03±0.23 and 0.10±0.32 logMAR units after SB and PPV, respectively. The percentage of cases that achieved 20/25 vision was not significantly different after PPV or SB if cases that had concurrent cataract surgery were excluded (p=0.251).ConclusionsBetter BCVA in patients with RRD who had undergone PPV was observed. However, if concurrent cataract surgery is not performed, BCVA will be comparable with either PPV or SB.

scholarly journals On functional results of treatment of recurrent rhegmatogenous retinal detachment after multiple endovitreal interventions

2019 ◽  
Vol 12 (2) ◽  
pp. 5-10
Author(s):  
Andrei D. Shchukin
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Present Report ◽  
Vitreoretinal Surgery ◽  
Functional Results ◽  
Scleral Buckling ◽  
City Hospital ◽  
Results Of Treatment ◽  
The City ◽  
Retinal Photocoagulation

The present report is an extension of the study, in which on a large clinical material, the ratio of procedures used at this time for retinal detachment was shown, and the frequency of relapses after extrascleral and endovitreal surgeries was analyzed. The purpose of the study is to determine the terms of relapse occurrence, and to estimate visual function after multiple endovitreal procedures. Materials and methods. The study was carried out in the Ophthalmological Center of the City Hospital No. 2 of St. Petersburg. The data of 116 case histories of 23 patients (28 eyes) repeatedly admitted to the department of vitreoretinal surgery of the center and operated (2 to 7 times) for recurrent rhematogenous retinal detachment in 2015-2016 were analyzed. Results. Multistage endovitreal surgery in patients with recurrent retinal detachment in most cases (78.6%) leads to significant decrease of visual functions; in incomplete retinal adherence in the lower segments after extrascleral surgery, additional scleral buckling or barrier laser retinal photocoagulation can be used.

scholarly journals Successful Surgical Treatment of Traumatic Macular Hole With Total Rhegmatogenous Retinal Detachment in a Child- a Case Report

2021 ◽  
Author(s):  
Sławomir Cisiecki ◽  
Karolina Boninska ◽  
Maciej Bednarski
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Rhegmatogenous Retinal Detachment ◽  
Functional Results ◽  
Scleral Buckling ◽  
Case Presentation ◽  
Hand Motion ◽  
Silicon Oil ◽  
Flap Technique ◽  
Morphologic Characteristics

Abstract Background: To investigate the surgical results and morphologic characteristics of pediatric traumatic macular hole with total rhegmatogenous retinal detachment.Case presentation: The 4-year-old-male patient underwent scleral buckling surgery combined with vitrectomy with the inverted ILM flap technique and silicon oil tamponade for five months. Complete ophthalmic examination was performed preoperatively and 7 days, 1, 3, 6, 9 and 12 months after surgery. Successful retinal reattachment was achieved and the macular hole was successfully closed. Visual acuity improved from Hand Motion at the initial visit to 20/80 (0.6 LogMAR) postoperatively.Conclusions: Scleral buckling surgery and vitrectomy with the inverted ILM flap technique appeared to give effective anatomical and functional results in this case.

scholarly journals The Impact of the Covid-19 Pandemic on Rhegmatogenous Retinal Detachment Treatment Patterns

2021 ◽  
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedures ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Retinal Breaks ◽  
Surgery Outcomes ◽  
Potential Factors ◽  
Subretinal Fluid Drainage ◽  
The Impact

Abstract Background: To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 pandemic. Material and 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. 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 leads to comparable surgery outcomes.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedures ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Retinal Breaks ◽  
Surgery Outcomes ◽  
Potential Factors ◽  
Subretinal Fluid Drainage ◽  
The Impact

Abstract 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.

Pneumatic Retinopexy; Indications and Techniques

2019 ◽  
pp. 181-186
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Invasive Procedure ◽  
Scleral Buckling ◽  
Minimally Invasive Procedure ◽  
Postoperative Rehabilitation ◽  
Pneumatic Retinopexy ◽  
Indirect Ophthalmoscopy ◽  
Pars Plana

Pneumatic retinopexy is a minimally invasive procedure for repairing rhegmatogenous retinal detachment. PR is an excellent option in carefully selected patients, but skillful use of indirect ophthalmoscopy and more preoperative time is required for examination and to prepare and educate patients. Although it is associated with reduced morbidity, reduced cost, and faster postoperative rehabilitation compared to pars plana vitrectomy and scleral buckling, it is currently underutilized.

scholarly journals Lipid Peroxidation in Subretinal Fluid: Some Light on the Prognosis Factors

Biomolecules ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 514
Author(s):  
Francisco Bosch-Morell ◽  
Enrique García-Gen ◽  
Salvador Mérida ◽  
Mariola Penadés ◽  
Carmen Desco ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Clinical Aspects ◽  
Prognosis Factors ◽  
Evolution Time ◽  
Refractive Status ◽  
And Oxidative Stress

The aim of this study was to identify a relation between the clinical characteristics and differences in lipid peroxidation in the subretinal fluid (SRF) of rhegmatogenous retinal detached patients by malondialdehyde (MDA) quantification. We collected 65 SRF samples from consecutive patients during scleral buckling surgery in rhegmatogenous retinal detachment (RRD) eyes. In addition to a complete ophthalmic evaluation, we studied the refractive status, evolution time, and the number of detached retinal quadrants to establish the extension of RRD. We studied the clinical aspects and oxidative stress and compared the characteristics among groups. We found that neither the evolution time of RRD nor the patients’ age correlated with the MDA concentration in the SRF. The MDA and the protein content of the SRF increased in the patients with high myopia and with more extended RRD. Our results suggest that oxidative imbalance was important in more extended retinal detachment (RD) and in myopic eyes and should be taken into account in the managing of these cases.

scholarly journals Scleral buckling—a brief historical overview and current indications

2019 ◽  
Vol 258 (3) ◽  
pp. 467-478
Author(s):  
Aijing Wang ◽  
Martin P. Snead
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Effective Technique ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Pars Plana ◽  
Retinal Hole ◽  
The Right

AbstractThe key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

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