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Graefe's Archive For Clinical and... Mar 2020The 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... (Review)
Review
The 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.
Topics: History, 20th Century; History, 21st Century; Humans; Retinal Detachment; Scleral Buckling
PubMed: 31828426
DOI: 10.1007/s00417-019-04562-1 -
Indian Journal of Ophthalmology May 2024
Topics: Humans; Scleral Buckling; Retinal Detachment
PubMed: 38648430
DOI: 10.4103/IJO.IJO_247_24 -
Klinische Monatsblatter Fur... Apr 2019Buckling techniques are used for rhegmatogenous (break-induced) retinal detachment. The aim is to achieve a functional closure of the retinal breakwith permanent retinal...
Buckling techniques are used for rhegmatogenous (break-induced) retinal detachment. The aim is to achieve a functional closure of the retinal breakwith permanent retinal attachment by scleral indentation and coagulation of retinal holes. The surgery is primarily extraocular. The use of different buckling methods depends on various factors. The success rates are high at 54 - 97% after the initial procedure, but decrease as the macula is detached. When the possibilities of the scleral buckling procedures are exhausted, pars plana vitrectomy is the next therapeutical option. In recent years, however, there is a trend to primarily address even a simple rhegmatogenic retinal detachment with vitreous surgical methods.
Topics: Humans; Retinal Detachment; Scleral Buckling; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 30776843
DOI: 10.1055/a-0849-0069 -
Indian Journal of Ophthalmology Jul 2018Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. With the introduction of... (Review)
Review
Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. With the introduction of pars plana vitrectomy (PPV), there is a growing trend towards the use of PPV for treatment of retinal detachment. There is a reluctance to perform scleral buckling (SB) in RRD due to the perceived steep learning curve, declining mastery over indirect ophthalmoscopy, and poor ergonomics associated with SB. In this article, we discuss the surgical challenges and tips to overcome these in four headings: localization of the break, retinopexy, SB, and subretinal fluid (SRF) drainage. Localization of the break can be performed by the use of forceps or illuminated scleral depressor. It can be facilitated by prior drainage of SRF in cases with bullous RRD. Chandelier with wide-angle viewing system can be used for easier localization of break and cryopexy. Sutureless buckling and suprachoroidal buckling are easier and faster alternatives to the conventional technique. Reshaping the silicone segment helps in accommodating the wider circumferential band. Modified needle drainage, laser choroidotomy, and infusion-assisted drainage can make SRF drainage easier and safer. The above techniques and other practical tips have been explained in detail with the illustrations to make the process of learning the art of SB easier.
Topics: Drainage; Humans; Retinal Detachment; Scleral Buckling; Subretinal Fluid
PubMed: 29941729
DOI: 10.4103/ijo.IJO_136_18 -
Seminars in Ophthalmology 2018Scleral buckling has an important role in the repair of certain categories of rhegmatogenous retinal detachments. These include detachments in young phakic patients,... (Review)
Review
Scleral buckling has an important role in the repair of certain categories of rhegmatogenous retinal detachments. These include detachments in young phakic patients, detachments associated with dialysis, and also in conjuction with vitrectomy in patients who have sustained trauma or have developed proliferative vitreoretinopathy. However, it can be associated with significant postoperative complications. The most important ones are refractive change, intrusion or extrusion, infection, globe ischemia, and choroidal detachments, amongst others. Careful planning, appropriate patient selection, and good intraoperative technique can reduce the rate of these complications.
Topics: Humans; Postoperative Complications; Retinal Detachment; Scleral Buckling; Visual Acuity
PubMed: 29185844
DOI: 10.1080/08820538.2017.1353816 -
Retina (Philadelphia, Pa.) Nov 2023To report a technique for scleral buckling surgery under the operating microscope with wide-field viewing.
PURPOSE
To report a technique for scleral buckling surgery under the operating microscope with wide-field viewing.
METHODS
The identification and reliable marking of retinal breaks is one of the key steps for successful surgery in scleral buckling. For sufficient visualization of retinal breaks, some kind of indentation and illumination is necessary. In this technique, one instrument (Visible Periphery illuminated scleral indentor; Oertli Instrumente AG, Switzerland) combines scleral depression, illumination, and color marking (using a surgical marking pen) of the corresponding sclera above the retinal break.
RESULTS
The illuminated scleral depressor enables the surgeon to safely and precisely mark the retinal break while stabilizing and rotating the eye with the other hand. This technique simplifies scleral buckling surgery by improving the handling and visualization of marking retinal breaks at the corresponding scleral. Neither intraoperative indirect ophthalmoscopy nor sclerotomies for chandelier light systems or any intraocular instrument are necessary.
CONCLUSION
The illuminated scleral depressor facilitates scleral buckling surgery in a convenient way for easy and precise scleral marking of the retinal breaks even in challenging situations and positions of retinal breaks under the operating microscope with wide-field viewing. Indirect ophthalmology or other illumination sources are no longer needed.
Topics: Humans; Scleral Buckling; Sclera; Retinal Perforations; Retinal Detachment; Retrospective Studies; Visual Acuity; Treatment Outcome
PubMed: 37870910
DOI: 10.1097/IAE.0000000000003274 -
Graefe's Archive For Clinical and... Jan 2017
Topics: Decision Making; Humans; Retinal Detachment; Retinal Perforations; Scleral Buckling; Visual Acuity; Vitrectomy
PubMed: 27853953
DOI: 10.1007/s00417-016-3533-5 -
Ophthalmic Surgery, Lasers & Imaging... May 2020
Review
Topics: Humans; Retinal Detachment; Scleral Buckling; Total Quality Management
PubMed: 32511727
DOI: 10.3928/23258160-20200501-02 -
European Journal of Ophthalmology May 2020To introduce a modified technique for segmental buckling through a small in situ conjunctival opening without rectus muscle traction for minimally invasive repair of...
PURPOSE
To introduce a modified technique for segmental buckling through a small in situ conjunctival opening without rectus muscle traction for minimally invasive repair of uncomplicated rhegmatogenous retinal detachment.
METHODS
This technique was performed in 15 eyes of 15 selected patients with primary retinal detachment. Conventional traction sutures placed beneath rectus muscles were replaced by an absorbable translimbal traction suture at lesion quadrant. The conjunctival incision was made 8-9 mm posterior and parallel to the limbus. After cryopexy, a minimal explant was fixed with one to two sutures through the conjunctival opening, expanded by a pediatric speculum.
RESULTS
Retinal reattachments were achieved with correct buckle positions in all patients, with rapid cosmetic recovery.
CONCLUSION
This modified buckling technique simplifies the buckling procedure, minimizes surgical invasiveness, preserves intact limbal conjunctiva, and relieves discomfort.
Topics: Conjunctiva; Cryotherapy; Female; Humans; Male; Oculomotor Muscles; Retinal Detachment; Scleral Buckling; Suture Techniques; Sutures; Treatment Outcome; Young Adult
PubMed: 31177843
DOI: 10.1177/1120672119855861 -
Der Ophthalmologe : Zeitschrift Der... Jan 2008For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed... (Review)
Review
For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.
Topics: Germany; Humans; Plastic Surgery Procedures; Retinal Detachment; Scleral Buckling; Vitrectomy
PubMed: 18210120
DOI: 10.1007/s00347-007-1673-z