June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
AN INNOVATIVE APPROACH TO RETINAL DETACHMENT REPAIR WITH SCLERAL BUCKLING
Author Affiliations & Notes
  • Shulamit Schwartz
    Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
  • Eyal Cohen
    Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
  • Michael Rod Martinez
    Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
  • Anat Loewenstein
    Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
  • adiel barak
    Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
  • Footnotes
    Commercial Relationships Shulamit Schwartz, None; Eyal Cohen, None; Michael Martinez, None; Anat Loewenstein, None; adiel barak, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 5065. doi:https://doi.org/
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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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

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.

 
Methods
 

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.

 
Results
 

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.

 
Conclusions
 

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.  

 
Figure 1: Patient #10 SB procedure using a wide-angle viewing system for RRD<br /> Panel a- Placement of 25G chandalier after completion of a conjunctival peritomy and slinging of rectus muscles<br /> Panel b- Excellent fundus view of RRD and precise localization of multiple lower temporal quadrant breaks<br /> Panel c- Monitoring cryo application over a break with whitening of the overlying retina<br /> Panel d- Fundus view after explant placement. Note buckle position with good support of all breaks<br />
 
Figure 1: Patient #10 SB procedure using a wide-angle viewing system for RRD<br /> Panel a- Placement of 25G chandalier after completion of a conjunctival peritomy and slinging of rectus muscles<br /> Panel b- Excellent fundus view of RRD and precise localization of multiple lower temporal quadrant breaks<br /> Panel c- Monitoring cryo application over a break with whitening of the overlying retina<br /> Panel d- Fundus view after explant placement. Note buckle position with good support of all breaks<br />

 
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