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Azusa Fujikawa, Takeshi Kumagami, Eiko Tsuiki, Takashi Kitaoka; Evaluation of scleral buckling with chandelier illumination for rhegmatogenous retinal detachment. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1042.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate a wide-angle viewing system and chandelier illumination technique for use as a tool in scleral buckling for rhegmatogenous retinal detachment (RRD).
This retrospective comparative study examined 195 continuous case series of scleral buckling procedures for RRD performed between April 2008 and April 2015 at Nagasaki University Japan. Chandelier-assisted segmental buckling (CSB), standard segmental buckling (SSB) using indirect ophthalmoscope, chandelier-assisted encircling buckle (CEB), and standard encircling buckle (SEB) using indirect ophthalmoscope were included. Patients with proliferative vitreoretinopathy, those who underwent vitrectomy with encircling, those who had scleral buckling before, or those who dropped out within 6 months were excluded from the analyses. Statistical significance was determined by a Student’s two-tailed t-test and a chi-square test for comparisons among groups.
The study examined 38 patients in the CSB, 34 in the SSB, 26 in the CEB, and 42 in the SEB groups. The mean ages of the patients were 36.3±13.0, 39.3±19.5, 30.6±11.6 and 27.8±14.6 years in the CSB, SSB, CEB and SEB groups, respectively. No significant differences were observed between the groups. The primary reattachment rate of the segmental scleral buckling was similar, with successful attachment achieved in 34 of 38 eyes (89.5%) in the CSB group and in 31 of 34 eyes (91.2%) in the SSB group. For the encircling cases, successful attachment was achieved in 22 of 26 eyes (84.6%) in the CEB group and in 36 of 42 eyes (85.7%) in the SEB group. The surgical time for the segmental scleral buckling was significantly less in the CSB (92.1±26.8 minutes) versus the SSB group (107.1±34.6 minutes, P=0.046). For the encircling cases, the surgical time was also significantly less in the CSB (133.3±37.3 minutes) versus the SSB group (157.5±42.3 minutes, P=0.017).
While chandelier-assisted buckling exhibited similar outcomes compared to that for standard buckling, it does reduce the required surgical time by making the retinal tear easier to find using its wide-angled viewing system. In addition, diathermy with light illumination improves the ability to correctly mark the point of the retinal tear on the sclera using cautery. However, careful management of the chandelier is required in order to avoid touching the lens or causing infection in the vitreous.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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