Modified Controlled Encircling Scleral Buckle for Retinal Detachment.
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ABSTRACT:
SUBMITTER: Skondra D
PROVIDER: S-EPMC5672951 | biostudies-literature | 2017 Sep-Oct
REPOSITORIES: biostudies-literature
Publications
Modified Controlled Encircling Scleral Buckle for Retinal Detachment.
Skondra Dimitra D Westerfeld Corey C Vavvas Demetrios G DG
Journal of vitreoretinal diseases 20170821 5
During encircling scleral buckle placement, the ends of the element are tightened to achieve a shortened radius of the eye. The determining factor of the final buckle height is subjective using usually a combination of the buckle height visualized with the degree of scleral indentation and can be difficult to be taught early on to trainees. Here, we describe a case series in which a modified controlled encircling scleral buckle technique that simplifies and standardizes the achievement of reprod ...[more]
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Project description:IntroductionScleral 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.MethodsIn 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.ResultsThirty-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).ConclusionModified 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.
| S-EPMC7406596 | biostudies-literature
Project description:PurposeTo introduce a modified technique for encircling circumferential scleral buckling without peritomy thorough a small conjunctival opening for the repair of uncomplicated rhegmatogenous retinal detachment (RD).MethodsThis technique was performed in 10 eyes of 10 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling without peritomy. Transconjunctival traction sutures were placed in four rectus muscles. After transconjunctival location of the retinal break, a 5- to 6-mm radial conjunctival incision was performed in 4 quadrants without cutting the limbal conjunctiva-Tenon's capsule. A 240-silicone band in scleral belt loops was used for an encircling circumferential buckle. After drainage and cryopexy, SF6 was used for tamponade. The incision was closed via layered closure only ocassionally.ResultsPrimary attachment success of 100% was achieved by single procedure. The intraoperative and postoperative complications observed included subconjunctival hemorrhage observed in 5 (50%) of eyes. These disappeared in the postoperative period.ConclusionsMinimal conjunctival incision in scleral buckle without peritomy can achieve excellent anatomical success in patients with rhegmatogenous RD without distorting ocular surface anatomy. This is the first description of technique preserving corneal limbus anatomy that could convert buckling surgery to more attractive option for retina surgeons.
| S-EPMC6545391 | biostudies-literature
Project description:BackgroundRetinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. Select patients may benefit most from primary scleral buckling without vitrectomy, but lack adequate posterior segment ophthalmoscopic visualization to use standard techniques.Case presentationThe authors describe a retinal reattachment technique utilizing endoscope-assisted visualization to perform a primary scleral buckle procedure for a 34yo female with Peters' Anomaly and a macula-sparing retinal detachment. Retinal reattachment was achieved with a single procedure and she remained stable with preservation of baseline visual acuity at 30 months follow-up.ConclusionIn cases where a primary scleral buckle procedure is the preferred retinal detachment repair technique but posterior segment visualization is limited, intraoperative fundus examination, cryotherapy administration, and scleral buckle positioning can be facilitated with intraocular endoscopy.
| S-EPMC7659157 | biostudies-literature
Project description:Purpose. To report the anatomic and visual results of a new sutureless illuminated macular buckle designed for patients with macular hole retinal detachment related to high myopia (MMHRD). Design. Prospective nonrandomized comparative interventional trial. Methods. Twenty myopic eyes of 20 patients (mean age, 51.4 years; range, 35-65 years) presenting with MMHRD with a posterior staphyloma, in whom the new buckle was used, were evaluated. The buckle used was assembled from a 5 mm wide sponge and a 7 mm wide silicone tire; it was fixed utilizing the sterile topical adhesive Histoacryl Blue (B Braun, TS1050044FP) which polymerizes in seconds upon being exposed to water-containing substances. The primary outcomes measured included aided visual acuity (BCVA) and optical coherence tomography (OCT) findings. The mean follow-up period was 6 months. Results. Postoperatively, the MH closure was identified by OCT in 8 (40%) eyes. The mean BCVA increased from 0.11 to 0.21 (p < 0.005). The axial length of the eyes included decreased from 30.5 mm preoperatively to 29.8 mm (p = 0.002) postoperatively. Conclusion. Preparation of the new sutureless macular buckle is simple and easy. Illumination of the terminal part of the buckle ensures proper placement. Histoacryl Blue is effective in fixing the buckle in its place for at least 6 months with no reported intra- or postoperative complications.
| S-EPMC5376471 | biostudies-literature
Project description:To evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation.In this retrospective study, a chart review of all patients with RRD associated with subretinal proliferation who were primarily treated with scleral buckling procedure, from April 2007 to April 2014, was undertaken. Main outcome measures were anatomical retinal reattachment and visual acuity.Forty-four eyes of 43 patients including 24 males and 19 females with a mean age of 26.5±13.1 years were evaluated. Immediately after the surgery, retina was reattached in all eyes. However, five eyes (11.3%) needed additional surgery for retinal redetachment. Single surgery anatomical success rate was 88.7%. Four eyes (9.1%), needed pars plana vitrectomy for the treatment of redetachment associated with proliferative vitreoretinopathy and scleral buckle revision surgery was successfully performed in the other eye. Best corrected visual acuity improved from 1.5±0.9 logMAR before surgery to 1.1±0.7 logMAR after surgery (P<0.001). An improvement in BCVA of >2 lines was found in 23 eyes (52.2%) and worsening of best corrected visual acuity of >2 lines was observed in 2 eyes (4.5%).Scleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation.
| S-EPMC4816362 | biostudies-other
Project description:For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks remain open at the end of surgery. Various explanations have been put forward, but none more interesting than the effect of fluid currents associated with eye movements. One such explanation involved the physics of the Bernoulli's principle. Daniel Bernoulli was an eighteenth century Swiss mathematician and he described an equation based on the conservation of energy. The sum of pressure energy, potential energy and kinetic energy remains constant. Bernoulli's equation usually applies to closed system such as the flow of fluid through pipes. When fluid flows through a constriction, the speed of fluid increases, the kinetic energy increases. If there was no change in elevation (potential energy), then the increase in kinetic energy must be accompanied by a decrease in pressure energy. In ophthalmic surgery, the Bernoulli's effect is the basis for venturi pumps that drive vitrectomy and phacoemulsification machines. This essay expounds on how Bernoulli's effect might be relevant to scleral buckling for retinal detachment repair. In the era when vitrectomy is increasing the primary surgical operation for retinal detachment, the pervasive advice is to emphasise the importance of patient adopting head posture and remaining still postoperatively. The exception is non-drainage scleral buckling surgery. Early postoperative mobilisation may be vital to achieve reattachment.
| S-EPMC5811744 | biostudies-literature
Project description:PURPOSE: We conducted a study to investigate: (1) deviations caused by retinal detachment (RD) repair; (2) correlation between visual acuity and the number of surgeries to deviation size; and (3) differences between deviations following scleral buckling (SB) and pars plana vitrectomy (PPV). METHODS: A retrospective analysis of patients with persistent binocular diplopia following RD repair. Magnitude of manifest deviation (∣dev∣) in the primary position (PP) and position of greatest deviation (maxDev) was calculated. LogMAR acuity and number of previous vitreoretinal procedures were correlated to ∣dev∣ in both PP and maxDev. Manifest ∣dev∣ were compared between SB and PPV groups. RESULTS: Twenty-five patients were identified. The median ∣dev∣ was 7 prism diopters (PD) in PP and 17 PD in maxDev. We found no association between number of surgeries or VA with ∣dev∣ in either the PP (r=-0.18 and r=0.08) or maxDev (r=-0.26 and r=-0.05). Twelve patients underwent PPV: median ∣dev∣ in PP 6 PD and maxDev 9 PD. In the SB group: median ∣dev∣ in PP 8 PD and in maxDev 22 PD. ∣dev∣ in PP showed no significant differences between PPV and SB (U=63, P=0.41); however, ∣dev∣ in maxDev, showed that SB have significantly greater deviations (U=36.0, P=0.02). CONCLUSION: We report the largest cohort of patients with symptomatic ocular motility defects following PPV. We show no association between VA or number of procedures to strabismus magnitude. Ocular deviations in maxDev are significantly greater after SB procedures.
| S-EPMC3178247 | biostudies-other
Project description:PurposeScleral buckling is currently used in addition to vitrectomy for the treatment of pseudophakic retinal detachment (PRD) to better support the vitreous base and better visualisation of the periphery.AimsThe aims of this study are to evaluate (1) whether the combination of 20?G vitrectomy and scleral buckling is superior to 20?G vitrectomy alone (control) (confirmatory), and (2) whether transconjunctival 23/25?G vitrectomy is non-inferior to 20?G vitrectomy (both without scleral buckling) regarding operation success (exploratory).MethodsThe VIPER (Vitrectomy Plus Encircling Band Vs. Vitrectomy Alone For The Treatment Of Pseudophakic Retinal Detachment) study is an unmasked, multi-centre, three-arm randomised trial. Patients with PRD were eligible, excluding complicated retinal detachment or otherwise severe ophthalmologic impairment. Patients were randomised to one of three interventions: 20?G vitrectomy alone (control C), combination of 20?G vitrectomy and circumferential scleral buckling (experimental treatment E1) or 23/25?G vitrectomy alone (experimental treatment E2). The primary endpoint is the absence of any indication for a retina re-attaching procedure during 6?months of follow-up. Secondary endpoints include best corrected visual acuity, retina re-attaching procedures, complications and adverse events.ResultsFrom June 2011 to August 2013, 257 patients were enrolled in the study. The internet randomisation service assigned 100 patients each to the treatment arms C and E1, and 57 patients to treatment E2. The imbalance is due to the fact that several retinal surgeons did not qualify for performing E2. The random assignment was stratified and balanced (ie, 1:1 or 1:1:1 ratio) by surgeon.ConclusionsThe described study represents a methodologically rigorous protocol evaluating the benefits of three different vitrectomy approaches to PRD. The projected results will help to establish their overall efficacy and will permit conclusions regarding their relative value.Trial registration numberDRKS00003158 (German Clinical Trials Register, DRKS).
| S-EPMC4789721 | biostudies-literature
Project description:PurposeTo review the current literature on retinal displacement and provide a discussion of potential risk factors, postoperative outcomes, and future directions.MethodsTwo databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles on retinal displacement.ResultsWe identified 1522 articles. A total of n = 14 articles were retained. We provide an overview on the potential influence of surgical type (n = 4), tamponade agents (n = 5), postoperative posture (n = 6), and preoperative retinal status (n = 5) on incidence of retinal displacement and visual outcomes (n = 8). Discussion. Pars plana vitrectomy (PPV) with gas tamponade is associated with displacement rates of up to 72%, typically in a downward direction. Meanwhile, pneumatic retinopexy and PPV with silicone oil may offer similar surgical success with a significantly lower risk of displacement. The impact of heavy liquids such as perfluorocarbon liquid, postoperative positioning and preoperative extent of detachment on displacement remains inconclusive. Patients with displacement had a significantly lower visual acuity and higher rates of distortion than those without displacement. However, not all patients with displacement experienced visual symptoms.ConclusionRetinal displacement is a new concept in our understanding of retinal detachment. Additional studies are needed to better define its impact on postsurgical outcomes.
| S-EPMC8413052 | biostudies-literature
Project description:To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.A Markov model of cost-effectiveness and utility.There were no participants.Published clinical trials (index studies) of pneumatic retinopexy (PR), scleral buckling (SB), pars plana vitrectomy (PPV), and laser prophylaxis were used to quantitate surgical management and visual benefits. Markov analysis, with data from the Center of Medicare and Medicaid Services, was used to calculate the adjusted costs of primary repair by each modality in a hospital-based and ambulatory surgery center (ASC) setting.Lines of visual acuity (VA) saved, cost of therapy, adjusted cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY) saved.In the facility, hospital surgery setting, weighted cost for PR ranged from $3726 to $5901 depending on estimated success rate of primary repair. Weighted cost was $6770 for SB, $7940 for PPV, and $1955 for laser prophylaxis. The dollars per line saved ranged from $217 to $1346 depending on the procedure. Dollars per line-year saved ranged from $11 to $67. Dollars per QALY saved ranged from $362 to $2243. In the nonfacility, ASC surgery setting, weighted cost for PR ranged from $1961 to $3565 depending on the success rate of primary repair. The weighted costs for SB, PPV, and laser prophylaxis were $4873, $5793, and $1255, respectively. Dollars per line saved ranged from $139 to $982. The dollars per line-year saved ranged from $7 to $49, and the dollars per QALY saved ranged from $232 to $1637.Treatment and prevention of RD are extremely cost-effective when compared with other treatment of other retinal diseases regardless of treatment modality. Retinal detachment treatment costs did not vary widely, suggesting that providers can tailor patient treatments solely on the basis of optimizing anticipated results because there were no overriding differences in financial impact.
| S-EPMC4041093 | biostudies-literature