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S. A. Pilyugina, P. Huie, M. S. Blumenkranz; Modified Scleral Buckle: Extraconjunctival Approach. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2237.
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This experimental study was designed to develop a novel approach to scleral buckling utilizing a temporary encircling suture scleral buckle placed extraconjunctivally under the rectus muscles.
To demonstrate the possibility of buckling effect and measure the amount of indentation achieved with a suture buckle 15 porcine eyes were used.An 0-silk suture was sutured episclerally to each eye 8 mm posterior to the limbus using 7-0 nylon to bring the suture in contact with sclera but not to produce scleral indentation. The buckling effect was produced by progressive horizontal shortening of the suture around the globe in graduated 5 mm intervals. Intraocular pressure was maintained at 20 mm Hg by continuous infusion of saline. The buckle height and width were measured via vernier calipers after snap-freezing the globe in liquid nitrogen. The measurements were reproduced using immersion ultrasound biomicroscopy.The safety and efficacy of the temporary extraconjunctival suture buckle is evaluated in the rabbit animal model (study protocol approved by the Animal Institutional Review Board.) The buckle is placed in one eye of 16 rabbits and taken down at Day 7, and 14. The indentation parameters are evaluated prior to buckle removal using computerized tomography. The eyes are enucleated at Day 1, 7, 14 and 30 for histopathologic evaluation.
The porcine eye experiment revealed that encircling suture scleral buckle does produce an appreciable indentation effect. Buckle height increased linearly to 3.0 -3.5 mm at 15 mm of shortening. This effect was accompanied by a concomitant increase in buckle width to 6.0 mm.The animal model study is currently ongoing.
Development of a temporary extraconjunctival scleral buckle may be a useful supplement to the standard techniques of retinal detachment repair. It may also represent an advantageous procedure for the developing countries where standard buckling materials are not readily available.
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