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The British Journal of Ophthalmology Jan 2000To study the effects of segmental scleral buckling and encircling procedures on tissue circulation in the human optic nerve head (ONH) and choroid and retina.
AIMS
To study the effects of segmental scleral buckling and encircling procedures on tissue circulation in the human optic nerve head (ONH) and choroid and retina.
METHODS
Using the laser speckle method, the normalised blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 seconds and averaged over three pulses in the optic nerve head (NB(ONH)) and choroid and retina (NB(ch-ret)) in 10 patients with unilateral rhegmatogenous retinal detachment (mean age 52 (SD 17)). NB(ONH), NB(ch-ret), and intraocular pressure (IOP) in both eyes, and blood pressure (BP) were measured before, and 1, 4, and 12 weeks after the scleral buckling and encircling procedure.
RESULTS
NB(ch-ret) on the buckled side was significantly reduced after surgery and smaller than that in the unoperated contralateral eye throughout the study period (ANOVA, p<0.0001). NB(ch-ret) on the unbuckled side, in the foveal area, NB(ONH), IOP, and BP showed no significant change.
CONCLUSIONS
It was indicated that the segmental scleral buckling procedure with encircling elements decreased tissue blood velocity in the choroid and retina on the buckled side but caused no significant change on tissue circulation in other areas of the fundus or ONH.
Topics: Adult; Aged; Choroid; Female; Follow-Up Studies; Humans; Intraocular Pressure; Male; Middle Aged; Optic Nerve; Regional Blood Flow; Retinal Detachment; Retinal Vessels; Scleral Buckling; Treatment Outcome
PubMed: 10611096
DOI: 10.1136/bjo.84.1.31 -
The Cochrane Database of Systematic... May 2015Rhegmatogenous retinal detachment (RRD) is a full-thickness break in the sensory retina, caused by vitreous traction on the retina. While pneumatic retinopexy, scleral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rhegmatogenous retinal detachment (RRD) is a full-thickness break in the sensory retina, caused by vitreous traction on the retina. While pneumatic retinopexy, scleral buckle, and vitrectomy are the accepted surgical interventions for eyes with RRD, their relative effectiveness has remained controversial.
OBJECTIVES
The objectives of this review were to assess the effectiveness and safety of pneumatic retinopexy versus scleral buckle or pneumatic retinopexy versus a combination treatment of scleral buckle and vitrectomy for people with RRD. The secondary objectives were to summarize any data on economic measures and quality of life.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 January 2015.
SELECTION CRITERIA
We included all randomized or quasi-randomized controlled trials comparing the effectiveness of pneumatic retinopexy versus scleral buckle (with or without vitrectomy) for eyes with RRD.
DATA COLLECTION AND ANALYSIS
After screening for eligibility, two review authors independently extracted study characteristics, methods, and outcomes. We followed systematic review standards as set forth by The Cochrane Collaboration.
MAIN RESULTS
We included two randomized controlled trials (218 eyes of 216 participants) comparing the effectiveness of pneumatic retinopexy versus scleral buckle for eyes with RRD. We identified no studies investigating the comparison of pneumatic retinopexy versus a combination treatment of scleral buckle and vitrectomy. Of the two included studies, one was a small study with 20 participants enrolled in Ireland and followed for an average of 16 months. The second study was larger with 196 participants (198 eyes) enrolled in the United States and followed for at least 6 months. Cautious interpretation of the results is warranted, since we graded the evidence as low to moderate quality due to insufficient reporting of study methods and imprecision and inconsistency among study results.Both studies showed fewer eyes achieving retinal reattachment in the pneumatic retinopexy group compared with the scleral buckle group by six-months follow-up (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.77 to 1.02, 218 eyes); however, we are uncertain as to whether the intervention has an important effect on reattachment because the results are imprecise. Eyes in the pneumatic retinopexy group also were more likely to have had a recurrence of retinal detachment by six-months follow-up (RR 1.80, 95% CI 1.00 to 3.24, 218 eyes); however, we are uncertain as to whether the intervention has an important effect on recurrence because the lower CI equals no difference. Neither study reported mean change in visual acuity, quality of life data, or economic measures. Differences between the pneumatic retinopexy group and scleral buckle group were uncertain due to small numbers of events with respect to operative ocular adverse events (RR 0.67, 95% CI 0.32 to 1.42, 218 eyes), development of cataract (RR 0.92, 95% CI 0.06 to 14.54, 198 eyes), glaucoma (RR 0.31, 95% CI 0.03 to 2.91, 198 eyes), macular pucker (RR 0.74, 95% CI 0.20 to 2.67, 198 eyes), and proliferative vitreoretinopathy (RR 0.94, 95% CI 0.30 to 2.96, 218 eyes). Fewer eyes in the pneumatic retinopexy group compared with the scleral buckle group experienced choroidal detachment (RR 0.17, 95% CI 0.05 to 0.57, 198 eyes) or myopic shift equal to or greater than 1 diopter spherical equivalent (RR 0.04, 95% CI 0.01 to 0.13, 198 eyes).
AUTHORS' CONCLUSIONS
The evidence suggests that pneumatic retinopexy may result in lower rates of reattachment and higher rates of recurrence than scleral buckle for eyes with RRD, but does not rule out no difference between procedures. The relative safety of the procedures is uncertain and the relative effects of these procedures in terms of other patient-important outcomes, such as visual acuity and quality of life, is unknown. Due to the limited information available between pneumatic retinopexy and scleral buckle procedures, future research addressing these evidence gaps are warranted.
Topics: Humans; Insufflation; Randomized Controlled Trials as Topic; Recurrence; Retinal Detachment; Scleral Buckling; Treatment Outcome
PubMed: 25950286
DOI: 10.1002/14651858.CD008350.pub2 -
BMC Ophthalmology Feb 2021The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal...
BACKGROUND
The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal detachment (RRD). We also examined related factors that may affect the delayed absorption of SRF.
METHODS
This retrospective study included patients who underwent successful SB surgery for the treatment of macula-off RRD and in which the retina was reattached after the surgery. The patients were categorized according to gender, duration, age, the number, and location of retinal breaks. Subfoveal choroidal thickness (SFCT), height of subretinal fluid (SRFH), and the choriocapillaris flow density (CCFD) within 3 × 3 mm macular fovea were included. Delayed absorption was determined by the SRF that remained unabsorbed for 3 months after the procedure. The endpoint was determined when the SRF could no longer be observed.
RESULTS
A total of 62 patients (63 eyes) were enrolled. In 35 eyes (56.45%) SRF was completely absorbed and in 28 (43.55%) eyes delayed absorption of SRF in macular areas was observed at 3 months after surgery. A young age (< 35 years), inferior retinal breaks were associated with good outcomes by applying multivariable analysis on the rate of SRF absorption after SB instead of gender, the number of breaks, and duration (p < 0.05). CCFD was significantly different between the SRF group and the non-SRF group after SB (0.66 ± 0.04% vs 0.63 ± 0.05%, P < 0.05). SRFH showed a moderate positive correlation with SFCT (r = 0.462, p = 0.000), however, using binary logistic regression analysis it was determined that SFCT was not related to the absorption of the SRF.
CONCLUSIONS
The absorption of SRF after SB may be correlated with choriocapillaris flow density. Age and location of breaks are significant factors affecting the absorption of SRF. The duration of disease is an uncertain factor due to several subjective reasons.
Topics: Adult; Female; Humans; Male; Retinal Detachment; Retrospective Studies; Scleral Buckling; Subretinal Fluid; Tomography, Optical Coherence
PubMed: 33588767
DOI: 10.1186/s12886-021-01853-2 -
Eye (London, England) Feb 2018For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks...
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.
Topics: Finite Element Analysis; Humans; Models, Theoretical; Retinal Detachment; Retinal Perforations; Rheology; Scleral Buckling; Visual Acuity
PubMed: 29350687
DOI: 10.1038/eye.2017.312 -
Ophthalmology Apr 2014To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.
OBJECTIVE
To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.
DESIGN
A Markov model of cost-effectiveness and utility.
PARTICIPANTS
There were no participants.
METHODS
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.
MAIN OUTCOME MEASURES
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.
RESULTS
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.
CONCLUSIONS
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.
Topics: Cost-Benefit Analysis; Cryosurgery; Health Care Costs; Humans; Laser Therapy; Markov Chains; Middle Aged; Quality-Adjusted Life Years; Retinal Detachment; Scleral Buckling; Visual Acuity; Vitrectomy
PubMed: 24411577
DOI: 10.1016/j.ophtha.2013.11.003 -
Ophthalmologica. Journal International... 2020To evaluate the efficacy and safety of 25-gauge illumination-aided scleral buckling (SB) combined with hyaluronate injection for the treatment of rhegmatogenous retinal...
PURPOSE
To evaluate the efficacy and safety of 25-gauge illumination-aided scleral buckling (SB) combined with hyaluronate injection for the treatment of rhegmatogenous retinal detachment (RRD).
METHODS
Forty-five cases were included in this retrospective study. Twenty-five cases of the treatment group received SB with the aid of endo-illumination and noncontact wide-angle viewing system combined with hyaluronate injection after subretinal fluid drainage, while 20 cases of the control group received conventional SB with binocular indirect ophthalmoscope combined with air injection. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and complications were observed and recorded.
RESULTS
The mean operation duration of the treatment group (42.06 ± 16.77 min) was significantly shorter than that of the control group (50.19 ± 21.61 min, p = 0.042). Only 1 case of the control group underwent a second surgery, and the final reattachment ratios of the 2 groups were both 100%. BCVA improved in both the treatment group (from 0.91 ± 0.79 to 0.42 ± 0.58 logMAR, p < 0.001) and the control group (from 0.82 ± 0.70 to 0.41 ± 0.37 logMAR, p = 0.001). The improvements of BCVA of the treatment group and control group were -0.49 ± 0.38 and -0.42 ± 0.46 logMAR, with no significant difference (p = 0.594). There was no significant difference in IOP and complications between the 2 groups.
CONCLUSIONS
25-gauge endo-illumination-aided SB combined with hyaluronate injection was safe and effective for RRD.
Topics: Adult; Aged; Female; Humans; Hyaluronic Acid; Intraocular Pressure; Intravitreal Injections; Lighting; Male; Middle Aged; Retinal Detachment; Retrospective Studies; Scleral Buckling; Viscosupplements; Visual Acuity; Young Adult
PubMed: 31955164
DOI: 10.1159/000504714 -
Acta Ophthalmologica May 2008To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome.
METHODS
This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s).
RESULTS
In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34-48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35-56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically.
CONCLUSION
With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.
Topics: Adolescent; Adult; Aged; Child; Cryosurgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Pilot Projects; Retinal Detachment; Retinal Perforations; Scleral Buckling; Treatment Outcome
PubMed: 18494727
DOI: 10.1111/j.1600-0420.2007.01037.x -
Eye (London, England) Oct 2008Visual results following vitreoretinal surgery for stages 4 and 5 retinopathy of prematurity are often disappointing, even when anatomic results are good. This poses the... (Review)
Review
PURPOSE
Visual results following vitreoretinal surgery for stages 4 and 5 retinopathy of prematurity are often disappointing, even when anatomic results are good. This poses the question whether the surgery or the post-operative care causes the optic atrophy. A hypothesis is proposed that ocular perfusion pressure (mean blood pressure minus intraocular pressure) during or after surgery may be too low to provide adequate ocular blood flow.
METHODS
This report analyses the published results of retinopathy of prematurity surgery, the techniques used, as well as data about blood pressure and intraocular pressure in premature infants.
RESULTS
Mean blood pressure in conscious premature infants is low and labile; it falls further under anaesthesia. Pre-operative intraocular pressure in retinopathy of prematurity patients is unknown, but intraocular pressure during vitrectomy is elevated, and likely elevated postoperatively.
CONCLUSIONS
Conditions during and after vitreoretinal surgery for retinopathy of prematurity are conducive to low ocular perfusion pressure and consequent ischaemia of the retina and optic nerve, which can contribute to poor visual results. Improved monitoring and control of ocular perfusion pressure is warranted.
Topics: Blood Pressure; Choroid; Female; Humans; Infant, Newborn; Infant, Premature; Intraocular Pressure; Male; Optic Atrophy; Postoperative Care; Regional Blood Flow; Retinal Detachment; Retinopathy of Prematurity; Scleral Buckling; Visual Acuity; Vitrectomy
PubMed: 18356931
DOI: 10.1038/eye.2008.18 -
BioMed Research International 2021To report the long-term results of scleral buckling using 25-gauge chandelier illumination.
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.
Topics: Adult; Aged; China; Humans; Lighting; Middle Aged; Retinal Detachment; Retrospective Studies; Scleral Buckling; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 35402605
DOI: 10.1155/2021/4628160 -
Eye (London, England) Dec 2018To evaluate anatomic and functional outcomes of patients treated with pars plana vitrectomy (PPV) with scleral buckling versus PPV with inferior retinectomy for... (Comparative Study)
Comparative Study
PURPOSE
To evaluate anatomic and functional outcomes of patients treated with pars plana vitrectomy (PPV) with scleral buckling versus PPV with inferior retinectomy for treatment of cases of primary rhegmatogenous retinal detachment (RRD) associated with proliferative vitreoretinopathy (PVR) and inferior retinal breaks.
METHODS
Retrospective, comparative, interventional, single-center study. Fifty-one eyes of fifty-one patients with primary RRD associated with inferior breaks and PVR grade C1 or more were reviewed over 3 years. Twenty-one eyes underwent PPV with encircling band 360° and thirty eyes underwent PPV with primary inferior retinectomy. The primary outcome was final anatomic success. Secondary outcomes included change in visual acuity, primary anatomical success, the mean number of operations, and incidence of postoperative complications.
RESULTS
Primary anatomical success of 85.7% was achieved in buckle group compared to 83.3% in retinectomy group (p = 0.82). Mean duration of follow-up and mean number of operations was 9.8 ± 2.26 and 9.97 ± 2.44 months; 1.24 ± 0.62 and 1.3 ± 0.75 in buckle group and retinectomy group, respectively, achieving final anatomical success of 95.2% for the buckle group and 90% for the retinectomy group with no statistical significant difference (p = 0.49). Although visual acuity (logMAR) was better in the buckle group in the 1st month, it became nearly equal thereafter during the follow-up period (p = 0.5).
CONCLUSION
Similar anatomical and functional outcomes were achieved by combining PPV with scleral buckle or inferior retinectomy for treatment of primary RRD with PVR and inferior breaks.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Scleral Buckling; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 30116008
DOI: 10.1038/s41433-018-0194-0