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Shulamit Schwartz, Eyal Cohen, Michael Rod Martinez, Anat Loewenstein, adiel barak; AN INNOVATIVE APPROACH TO RETINAL DETACHMENT REPAIR WITH SCLERAL BUCKLING . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5065.
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Controversy exists regarding the optimal treatment of uncomplicated rhegmatogenous retinal detachment (RRD). Vitrectomy and scleral buckling (SB) have comparable outcome. Treatment is determined primarily by surgeon's preference, with a trend towards primary vitrectomies in recent years.<br /> We evaluate the outcome of scleral buckling using a wide-angle viewing system (BIOM) instead of the standard indirect ophthalmoscopy in the treatment of RRD.
An interventional case series of phakic eyes with primary RRD, preequatorial breaks, not complicated by proliferative vitreoretinopathy (PVR) and eligible for SB technique. The surgical procedure consisted of cryo therapy using a BIOM system and a 25 gauge chandalier, inserted through the pars plana for direct retinal visualization. A silicone encircling band was placed afterwards. This approach enabled a better assessment of breaks and a controlled cryopexy. Primary outcome was anatomical success. Secondary outcomes were postoperative complications and visual acuity (VA) at 3 and 6 months follow up.
Eleven eyes of eleven patients (four males and seven females) were included. Mean age was 38.2± 13.9 years and median myopia was 6 diopter. All eyes were phakic, nine of them with clear lenses. 45.5% had more than one break. 54.5% of breaks were located in the lower quadrants. Only one eye had macular involvement. Initial reattachment was achieved in all eyes. None of the eyes developed endophthalmitis, hypotony, PVR or re detachment. Average VA was 0.15 log MAR before and 3, 6 months after treatment. Cataract progressed in one elderly patient with slightly decreased vision.
Cryopexy using a BIOM system can be successfully and safely performed during a SB procedure for RRD. Potential complications of chandalier insertion were not seen and does not compromise the viability of subsequent procedures.
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