Scleral buckling methods for rhegmatogenous retinal detachment

Scleral buckling techniques are effective in treating most eyes with rhegmatogenous retinal detachment, and usually the final visual result is limited only by possible preexisting macular damage due to the detachment. Still, a variety of techniques are used, including exoplant or implant methods for the scleral buckle; cryotherapy, diathermy, or photocoagulation to cause the chorioretinal adhesion; and drainage or nondrainage of subretinal fluid. Also, recent development of alternative surgical techniques such as vitreous surgery and/or intraocular gas injection have raised questions about the current role of scleral buckling methods. This article reviews the principles and techniques of scleral buckling for retinal detachment and describes the methods we have found most useful.     

外路手术治疗陈旧性裂孔性视网膜脱离

目的 探讨外路手术治疗陈旧性裂孔性视网膜脱离的疗效,分析陈旧性裂孔性视网膜脱离的临床特点.方法 陈旧性裂孔性视网膜脱离34例(34只眼),在双目间接检眼镜直视下行裂孔及变性区定位,在裂孔及变性区周围行视网膜冷凝后,根据情况分别采用巩膜表面加压术、环扎术或环扎加压术.术后定期观察视力、玻璃体及视网膜复位情况.结果 ①随访1～6个月,术后视网膜裂孔封闭,完全复位28只眼,再脱离6只眼,均发生在手术后1个月;其中2例手术后不足10d再脱离.②视力情况:视力提高28只眼,矫正视力＜0.3者18只眼,≥0.3者10只眼.③视网膜下液吸收情况:3d完全吸收19例,6d完全吸收7例,3～4周吸收2例.④冷凝反应:Ⅰ级10只眼,Ⅱ级14只眼,Ⅲ级4只眼.结论 在双目间接检眼镜直视下,外路手术治疗陈旧性裂孔性视网膜脱离的手术效果良好,值得临床推广.手术后视网膜的复位和视力与病程有密切关系.陈旧性裂孔性视网膜脱离多是因为早期的误诊造成,应引起临床医生注意.     

Scleral buckling surgery for rhegmatogenous retinal detachment with subretinal proliferation

Purpose

To evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation.

Methods

In this retrospective study, a chart review of all patients with RRD associated with subretinal proliferation who were primarily treated with scleral buckling procedure, from April 2007 to April 2014, was undertaken. Main outcome measures were anatomical retinal reattachment and visual acuity.

Results

Forty-four eyes of 43 patients including 24 males and 19 females with a mean age of 26.5±13.1 years were evaluated. Immediately after the surgery, retina was reattached in all eyes. However, five eyes (11.3%) needed additional surgery for retinal redetachment. Single surgery anatomical success rate was 88.7%. Four eyes (9.1%), needed pars plana vitrectomy for the treatment of redetachment associated with proliferative vitreoretinopathy and scleral buckle revision surgery was successfully performed in the other eye. Best corrected visual acuity improved from 1.5±0.9 logMAR before surgery to 1.1±0.7 logMAR after surgery (P<0.001). An improvement in BCVA of >2 lines was found in 23 eyes (52.2%) and worsening of best corrected visual acuity of >2 lines was observed in 2 eyes (4.5%).

Conclusions

Scleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation.     

Scleral buckling for rhegmatogenous retinal detachment associated with severe myopia

From Jan. 1, 1980, to Dec. 31, 1989, we performed scleral buckling surgery on 48 eyes of 46 patients for rhegmatogenous retinal detachments associated with severe myopia (greater than 5.00 diopters). Forty eyes of 38 patients were observed for at least six months, and the mean follow-up period was 46 months. Intraoperative complications occurred in four of 48 eyes (8%) and included retinal incarceration (two eyes), choroidal hemorrhage (one eye), and choroidal detachment (one eye). Three of the 40 eyes (7.5%) followed up for more than six months developed a recurrent retinal detachment and underwent a revision of the scleral buckle. At the last follow-up examination, the retinas of all 40 eyes were totally reattached. Final visual acuity of 20/40 or better was attained in 26 of 40 eyes (65%). Because of the low rate of intraoperative complications and the high rate of success, scleral buckling is recommended for most patients with rhegmatogenous retinal detachments associated with severe myopia.     

Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole

PURPOSE: To determine the effectiveness of scleral buckling with a macular plombe in eyes with myopic macular retinoschisis and retinal detachment without a macular hole. DESIGN: A prospective, consecutive interventional case series. METHODS: Setting: Clinical practice at university hospitals. Patient Population: Six eyes of five consecutive patients with myopic macular retinoschisis and retinal detachment without a macular hole. Intervention Procedure: Scleral buckling with a macular plombe. Main Outcome Measures: The best-corrected visual acuity (BCVA), ophthalmoscopic appearance of fundus, and optical coherence tomographic images were recorded preoperatively, and at two weeks, at one, three, and six months, and then every three months thereafter. RESULTS: The mean retinal thickness was reduced significantly by the macular plombe (P < .05). The BCVA was improved by 2 lines or more in four eyes (66%), and remained within 2 lines of the preoperative BCVA in two eyes (34%). The complications were subretinal hemorrhage without choroidal neovascularization in one eye, and a progression of choroidal neovascularization with subretinal hemorrhage, which caused a transient visual impairment in one eye. CONCLUSIONS: We recommend that macular scleral buckling with a macular plombe be considered for eyes with myopic macular retinoschisis and retinal detachment without a macular hole.     

巩膜扣带术治疗孔源性视网膜脱离

目的 观察巩膜扣带术治疗孔源性视网膜脱离的疗效。方法 160例（168眼）行巩膜扣带术，术中均在双目间接检眼镜直视下定位裂孔、冷凝封闭裂孔。术后随访，观察视网膜复位情况。结果 本组病例初次手术视网膜解剖复位率94．0％。二次巩膜扣带术后视网膜解剖复位率为97．6％。结论 巩膜扣带术是治疗孔源性视网膜脱离的有效方法。合理联合视网膜下液引流、玻璃体气体填充及眼底激光光凝可提高手术成功率。     

非凝固手术联合氪多波长激光治疗单纯孔源性视网膜脱离

目的：探讨将巩膜扣带术中冷凝改为术后氪多波长激光光凝封闭裂孔治疗视网膜脱离的疗效、适应证范围及临床意义。方法：回顾性分析2001／2003在我院行非凝固巩膜扣带手术联合术后氪多波长激光封闭裂孔治疗孔源性视网膜脱离36例(36眼)，观察其疗效并对结果进行评价。结果：术后随访3-24mo，视网膜完全复位的32例，术后0．5a后矫正视力≥0．132例，最佳矫正视力为1．5。结论：非凝固巩膜扣带术联合氪多波长激光治疗单纯孔源性视网膜脱离，简化了手术操作，无凝固手术相关的并发症，术后采用氪多波长激光封闭裂孔，可以根据裂孔的部位及届光介质混浊的程度选用不同波长的激光进行封孔，是治疗单纯孔源性视网膜脱离的有效方法之一。     

巩膜外垫压术治疗家族性渗出性玻璃体视网膜病变合并孔源性视网膜脱离

目的 探讨巩膜外垫压术治疗家族性渗出性玻璃体视网膜病变合并孔源性视网膜脱离的效果.方法 回顾性分析2011年1月至2012年10月间在我院住院行巩膜外垫压术（或联合环扎术）治疗的6例（6只眼）家族性渗出性玻璃体视网膜病变合并孔源性视网膜脱离患者的临床资料.本组所有患者视网膜裂孔检查明确,且位于赤道或赤道前,增生性玻璃体视网膜病变C2级以下;具有阳性家族史;荧光素眼底血管造影特征明显.其中1个裂孔者4只眼,2个裂孔者2只眼.1例硅胶海绵纵行垫压,5例硅胶轮胎环行垫压并联合环扎.所有患者术后均补充视网膜激光光凝.结果 6例患者术后视网膜均复位良好,视力改善,经激光治疗无灌注区,随访稳定.结论 对于家族性渗出性玻璃体视网膜病变合并孔源性视网膜脱离患者,选择部分病例行巩膜外垫压手术治疗,术后及时补充视网膜激光光凝,可取得很好效果.     

巩膜扣带术联合532间接眼底镜激光治疗孔源性视网膜脱离

目的 探讨将巩膜扣带术中冷凝改为间接眼底镜激光光凝封闭裂孔，治疗孔源性视网膜脱离的疗效和适应证范围。方法回顾性分析2003年12月～2005年4月在我院行巩膜扣带术接受532间接眼底镜激光光凝治疗RD患者26例（26眼）的临床资料。结果术后随访3～6个月，26眼中视网膜全部复位。结论将巩膜扣带术中的冷凝改为532间接眼底镜激光光凝可减少视网膜和脉络膜损伤及术中并发症发生，是治疗RD的有效方法之一。     

Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks.

Between 1975 and 1989, 11 eyes were treated for retinal detachments with both peripheral and full thickness macular breaks. Long term retinal reattachment was dependent on successful closure of peripheral retinal breaks. Direct treatment of the macular break was necessary in only one case, which redetached 3 months after vitrectomy. Vitrectomy is not the initial treatment of choice for uncomplicated retinal detachments with both peripheral and full thickness macular breaks, unless required for the closure of the peripheral retinal breaks.     

不放液的节段性外垫压术与放液的巩膜环扎加压术的疗效比较

目的探讨不放液的节段性外垫压手术与放液的巩膜环扎加压术治疗孔源性视网膜脱离(RRD)的疗效,并对两种术式疗效进行比较。方法回顾分析181例(184只眼)增生性玻璃体视网膜病变(PVR)C2级以下改变的RRD行不放液的节段性外垫压手术与巩膜环扎加压、引流视网膜下液手术的临床资料。全部患者均为我院首诊病例,按手术中是否放液分为放液组和不放液组,分别分析各组PVR级别与视网膜解剖复位率的关系,并对二组的手术并发症、术后视力进行比较。181例患者术后随访时间2~48个月,平均8.6个月。结果放液组视网膜复位84只眼,手术成功率为91.3%;不放液组视网膜复位86只眼,手术成功率为93.5%。放液组和不放液组PVR不同级别(B,C级)视网膜复位率比较其差异无显著性意义(P>0.05)。而二组的手术并发症、术后视力进步率比较,不放液组手术并发症明显比放液组低,术后视力进步率较放液组高,其差别有显著性意义(P<0.01)。结论不放液的节段性外垫压手术与放液的巩膜环扎加压术复位率基本一致,但术后视力明显提高,手术并发症少,为手术步骤的重要改变,PVRC2级以下改变的RRD都可适用。     

Scleral buckling combined with vitrectomy for the management of rhegmatogenous retinal detachment associated with inferior retinal breaks

AIM: The use of adjunctive scleral buckling during vitrectomy for retinal detachment associated with inferior breaks has been the recent focus of some debate. It has been suggested that any benefit might be outweighed by potential complications associated with buckling surgery. The purpose of this study was to compare the success rate of vitrectomy, gas, and supplementary scleral buckling with the results of two recently published case series suggesting that acceptable results in inferior break detachments can be achieved with vitrectomy and gas alone. METHODS: A retrospective analysis of 60 consecutive patients with inferior break retinal detachments was conducted. All patients underwent vitrectomy, gas, and scleral buckling. In all cases, fellow eyes were examined under anaesthesia for retinal breaks if posterior vitreous detachment (PVD) had occurred at the time of presentation. Demographics, preoperative, and postoperative complications and outcome were recorded. RESULTS: Primary retinal attachment at 3 months was achieved in 95% of patients. This exceeds success rates of published data of patients who underwent vitrectomy and gas without buckling (81-89%). In patients with PVD in the fellow eye, 53% had horseshoe tears and all were treated with cryopexy. No sight-threatening complications occurred, but five patients developed minor buckle-related complications postoperatively. CONCLUSION: Supplementary scleral buckling is a safe procedure that improves and enhances primary success rates in inferior break detachments over vitrectomy and gas without buckling. There is a high rate of PVD-related breaks requiring treatment in the fellow eyes.     

玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离

目的　观察玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离患者术后视网膜的解剖复位率和黄斑裂孔的闭合率。方法　收集自２０１２年１月至２０１４年１２月在我院手术的高度近视合并黄斑裂孔性视网膜脱离的患者６４例（６４眼）,根据手术方式不同分成２组:一组行单纯玻璃体切割术为单纯玻切组,另一组行玻璃体切割联合黄斑加固术为联合手术组,观察两组视力及视网膜解剖复位率和黄斑裂孔闭合率。结果　６４例６４眼中,单纯玻切组３６例,术前视力平均为０．９０ｌｏｇＭＡＲ,术后平均为０．４１ｌｏｇＭＡＲ;联合手术组２８例,术前视力平均为０．８９ｌｏｇＭＡＲ,术后平均为０．６２ｌｏｇＭＡＲ;两组术前视力差异无统计学意义,术后差异有统计学意义（Ｐ＝０．０４）。两组患者术后视网膜复位均率为１００％;联合手术组的黄斑裂孔闭合率较高,为９２．９％,单纯玻切组为４１．７％,两组比较差异有统计学意义（Ｐ＝０．０２）。结论　在高度近视合并黄斑裂孔性视网膜脱离的患者中,联合行黄斑加固术较单纯玻璃体切割术患者的黄斑裂孔闭合率要高。     

孔源性视网膜脱离术后黄斑裂孔形成的原因分析

目的 探讨孔源性视网膜脱离术后黄斑裂孔形成的原因.方法 回顾性分析2017年10月至2019年12月武汉大学人民医院东院眼科所有孔源性视网膜脱离手术患者的临床资料,筛选术后发生黄斑裂孔的患者,结合光学相干断层扫描(OCT)检查结果分析黄斑裂孔形成的原因.结果 本研究共纳入孔源性视网膜脱离手术患者409例(423眼),其...     

Scleral buckling with chandelier illumination system in rhegmatogenous retinal detachment surgery: a large case series

AIM: To evaluate advantages of chandelier illumination system during scleral buckling (SB) procedures for rhegmatogenous retinal detachment (RRD) surgery. METHODS: In this comparative, retrospective study, 72 eyes of 72 patients undergoing SB for RRD at Minerva Hospital (Santa Maria Capua Vetere, Italy), divided in 2 groups of 36 eyes each were collected. In one group (A) eyes underwent SB with chandelier, in the other one (B) eyes underwent SB without using chandelier illumination system. Every eye of both groups was checked before surgery and at 1, 3, 7, 14, 30, 90 and 180d follow up. Parameters such as additional procedures, best spectacles visual acuity (BSVA; measured with Snellen Lines as decimal fraction), surgical time and retinal breaks recurrences had been analyzed before and after surgery and statistical comparison have been run between two groups. RESULTS: A significant (P<0.01) improvement in BSVA was observed at 6mo follow up in both groups; comparing groups A and B, no significant clinical differences was found in recurrences rate whereas mean surgical time in group A was statistically lower than the group B ones. CONCLUSION: According to results observed, even if they need to be confirmed in further studies with larger population, chandelier illumination system could be considered a valuable tool for SB surgery in eyes affected by RRD.