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K. R. Sivaraman, J. Jonisch, K. J. Blinder, G. K. Shah; Complications of Retinal Detachment Surgery Using Scleral Buckles. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6066.
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© ARVO (1962-2015); The Authors (2016-present)
To report the outcomes and postoperative complications of retinal detachment surgery with the use of scleral buckle techniques with and without vitrectomy.
Retrospective chart review of all patients undergoing retinal detachment repair with a scleral buckle at the Barnes Retina Institute between January 2001 and December 2008. Patients who underwent initial surgery at an outside institution or who were under 18 years of age at the time of surgery were excluded. In addition to basic demographic information, charts were reviewed for pre- and post-operative visual acuities (VA) and other post-operative complications, including retinal redetachment, proliferative vitreoretinopathy (PVR), buckle removal, buckle extrusion/migration/exposure, diplopia, epiretinal membranes, cystoid macular edema (CME), and elevated intraocular pressure.
895 eyes were included in this study with an average of 24.3 months of follow-up. There were 303 eyes that underwent SB alone (SB group) and 592 who underwent SB and PPV (SB/PPV group). Approximately 60% of buckles were placed using scleral belt loops, with the remainder using sutures or a combination of loops and sutures. For all comers, the mean preoperative VA was 20/160 (0.904 LogMAR units) and the mean postoperative VA was 20/74 (0.571 LogMAR units), with an average change of -0.325 LogMAR units (p < 0.0001). The overall rate of redetachment was 15.2%, with an incidence of 15.20% in the PPV/SB group and 15.18% in the SB group (p=0.9936). Only 1 of 895 (0.1%) of buckles was removed (due to exposure). PVR requiring vitrectomy occurred in 8.4% of eyes, with an incidence 10.3% in the PPV/SB group and 4.6% in the SB group (p = 0.0037). 5.3% of patients experienced diplopia with 1.0% needing strabismus surgery. The remaining cases of diplopia were minor and either self-limited or treated with prisms only. Other major surgery-related complications included CME (6.7%), visually significant epiretinal membrane (5.0%), postoperative uveitis (1.7%), macular hole (1.0%), increased intraocular pressure (0.6%), choroidal detachment/effusion (0.3%), scleral rupture during belt loop creation (0.1%), buckle extrusion (0.1%), buckle migration (0.1%), buckle exposure (0.1%), and buckle removal (0.1%).
Modern day buckling elements have a much lower incidence of complications and removal. Scleral buckling surgery remains a successful procedure for the repair of retinal detachments and results in good visual acuity with few complications.
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