A Method of Circular Scleral Buckle Length Calculation in Retinal Detachment Surgery

Purpose. To develop a method of circular buckle length calculation for optimization of circular scleral buckling in retinal detachment surgery.Methods. At the first stage of the study a formula for calculation of optimal circular scleral buckle length for patients with various axial length (AL) of the eyeball was developed (90 eyes). These healthy eyes were divided into three groups, 30 eyes in each: group 1 — AL 19 to 23.5 mm, group 2 — AL 23.6 to 27 mm, group 3 — AL over 27 mm. In all the groups AL and equatorial diameter of the eyeball were measured with ultrasound A- and B- scanning (Тomey UD8000, Tomey AL 3000). Mathematic estimation of equatorial eyeball diameter dependence on AL was performed using correlation and regression analysis and the formula for optimal circular buckle length calculation was derived. At the second stage the derived formula was used in clinic during retinal detachment surgery in 15 eyes of 15 patients aged 28 to 44 years (37.6 ± 2.6) with subtotal retinal detachment occupying 2 to 3 quadrants. Follow-up period was 1 to 4 months (2.3 ± 0.5). For control, in all patient’s intraoperative measurement of the eyeball circumference in equatorial zone was performed.Results. The first step of the study revealed high correlation coefficient (r) between AL and equatorial eyeball diameter in groups 1 and 2, 0.89 and 0.87, respectively. In group 3 correlation coefficient was 0.57 which shows moderate correlation between AL and equatorial eyeball diameter. Group 3 (AL > 27 mm) was not included in deriving the formula for circular buckle length calculation. Finally, regression equation was obtained and the following formula for circular buckle length calculation was derived: L = 0.9π (8.05 + 0.66 AL), where L — circular buckle length, π = 3.14, AL — axial length of the eyeball. At the second stage of the study (eyes with AL less than 27 mm) anatomical attachment of the retina was achieved in all 15 cases (100 %), elevation of the buckle was 1.44 to 1.6 mm (1.5 ± 0.02), circular buckle shortening made 10 % of the initial eyeball diameter. Control measurement of eyeball diameter in equatorial zone coincided with calculated values, that is, equaled the data obtained from presented formula and from preoperative ultrasound measurement of equatorial eyeball diameter.Conclusions. The derived formula for circular buckle length calculation is highly effective for eyes with AL less than 27 mm: provides optimal height of impression roll (approximately 1.5 mm), reduces the risk of postoperative complications, it is simple in use and shortens the operation time. For calculation of circular buckle length for eyes with AL over 27 mm it is reasonable to use the data of preoperative ultrasound A-scan measurement of equatorial diameter of the eyeball.

Outcomes of Combined Scleral Buckling Plus Pneumatic Retinopexy Vs. Scleral Buckling for Primary Rhegmatogenous Retinal Detachment

Purpose To evaluate the outcomes and complications of scleral buckle surgery alone or combined with pneumatic retinopexy (pneumatic buckle) for the treatment of primary rhegmatogenous retinal detachment. Design Retrospective chart review. Participants Two hundred thirteen patients with rhegmatogenous retinal detachment of whom 101 underwent primary scleral buckle surgery at Rabin Medical Center in 2005–2015 (SB group) and 112 underwent pneumatic buckle surgery at Royal Alexandra Hospital in 2013–2015 (PB group). Methods All patients were followed for ≥12 months. Data on clinical and surgical parameters, outcome, and complications were collected from the medical files. Main Outcome Measures Best corrected visual acuity and anatomical outcomes. Results At 12 months, average best corrected visual acuity was 0.3 logMar in the SB group and 0.42 logMar in the PB group ( P < 0.05). Rates of anatomical reattachment were high and similar in the two groups (99% and 97%, respectively, P = 0.623). The SB group had a higher percentage of patients requiring additional laser applications (21% vs. 7%; P < 0.01) and buckle readjustment surgery (6% vs. 0; P = 0.01), and the PB group had a higher percentage of patients who required postoperative pars plana vitrectomy (30% vs. 17%; P = 0.03). Conclusion Scleral buckle surgery alone is efficient for the treatment of rhegmatogenous retinal detachment. Its combination with pneumatic retinopexy usually has no significant added value in terms of anatomical reattachment rate. Outcomes of Pneumatic buckling vs Scleral Buckling for RRD

Chronic Macular Oedema as a Late MIRAgel-Related Complication

Background: MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle introduced in 1979 to treat rhegmatogenous retinal detachments. Its use was discontinued because late complications that require surgical removal were reported. Methods: Case report. Results: We report a case of left eye MIRAgel® buckle surgery 28 years ago presenting with a tender palpable erythematous swelling at the lower lid, with marked conjunctival chemosis and progressive ophthalmoplegia. Imaging revealed a large, well-defined, horseshoe-shaped lesion in the extraconal space of the left orbit with globe distortion, with histological confirmation of an expanded hydrogel buckle. He recovered well following removal of the explant but developed chronic macular oedema a year later, which persisted despite sub-Tenon’s triamcinolone injections. Repeat imaging demonstrated remaining hydrogel explant. Macular oedema settled well upon successful surgical removal with no recurrence to date. Conclusion: Our case is the first to describe macular oedema as a late MIRAgel-related complication, with complete removal of the explant being the definitive treatment. Macular oedema indicates postoperative inflammation secondary to the remaining explant fragments. Given the friability of hydrolysed MIRAgel®, we recommend ophthalmologists to warn patients regarding the possibility of further inflammation in the globe or the orbit in case of incomplete removal.

Supplemental scleral buckle for the management of rhegmatogenous retinal detachment by pars plana vitrectomy: A meta-analysis of randomized controlled trials

Objectives: The present review aims to synthesize evidence from randomized controlled trials (RCTs) that compared outcomes of pars plana vitrectomy (PPV) with and without a supplementary scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD). Methods: The authors searched MEDLINE, EMBASE, and CENTRAL to identify RCTs in English that compared PPV with and without supplemental SB. Risk of bias was assessed according to Cochrane Risk of Bias 2 tool. We present risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) estimated using random effects meta-analyses. Results: We identified six RCTs involving 705 eyes. Primary reattachment (6 studies, 345 eyes PPV, 324 eyes PPV+SB; RR 0.99, 95% CI 0.93-1.06, I2 = 0%, p = 0.78) and final anatomic success rates (4 studies, 272 eyes PPV, 267 eyes PPV+SB; RR 1.00, 95% CI 0.98-1.02, I2 = 0%, p = 0.89) were similar between the two groups. Postoperative visual acuity improvement (5 studies, 244 eyes PPV, 222 eyes PPV+SB; MD 6.09 letters, 95% CI -0.47-12.64, I2 = 69%, p = 0.07) and frequency of adverse events (6 studies, 1294 observations PPV, 1221 observations PPV+SB; RR 0.76, 95% CI 0.57-1.01, I2 = 25%, p = 0.06) likewise did not differ significantly between the treatment groups. Conclusion: Low-certainty evidence from RCTs did not demonstrate a benefit in placement of a supplemental scleral buckle during vitrectomy for management of RRD in the current analysis. Additional high-quality trials are needed to provide more precise estimates of effect.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.