Complex retinal detachments including retinal detachments that had previously undergone repair, tractional retinal detachments, and retinal detachments due to inflammation or endophthalmitis were excluded. We examined the outcomes of patients who received SBs (either primary scleral buckling or in combination with vitrectomy), and compared visual and anatomic outcomes, as well as the rates of postoperative strabismus, as defined as ocular misalignment. This report is a subgroup analysis of the PRO study. Institutional review board approval was obtained at each participating institution, and the study complied with the Health Insurance Portability and Accountability Act of 1996 and adhered to the tenets of the Declaration of Helsinki. Eye & Ear in Boston, and Mid Atlantic Retina/Wills Eye Hospital in Philadelphia. Louis, Associated Retinal Consultants/William Beaumont Hospital in Detroit, Mass. The Primary Retinal Detachment Outcome (PRO) study is a multicenter, interventional, retrospective cohort study of patients who underwent repair of noncomplex primary RRD from Januthrough Decemfrom VitreoRetinal Surgery in Minneapolis, The Retina Center in Minneapolis, The Retina Institute in St. The purpose of this paper is to present the anatomic outcomes following scleral buckling surgery comparing scleral tunnels to scleral fixated sutures, but additionally, to assess the development of postoperative strabismus between these two modalities. Similar to the lack of reports examining anatomic outcomes following the use of scleral tunnels or scleral sutures, there have been no reports assessing the development of strabismus comparing these two techniques for buckle fixation. The management of postoperative strabismus usually begins with prism therapy which may resolve the strabismus in the majority of patients, while other patients may require strabismus surgery or buckle removal. ĭiplopia from strabismus following SB surgery is often temporary, but chronic or permanent strabismus may also occur and is a well-known complication, with a reported incidence between 5% and 25%. ![]() The selection largely depends on surgeon's preference, and little data is available regarding comparative efficacy and outcomes. Currently, the most commonly performed is the use of scleral suturing to secure the SB directly on the surface of the sclera, but the use of scleral tunnels to affix the encircling buckle to the sclera is a popular technique as well. An initial report had a success rate of 65%, but over the years, scleral buckling has evolved and lamellar dissection is rarely performed. Schepens' initial technique describes a lamellar dissection of the sclera and placement of an element with external diathermy for retinopexy. 1986 6:1-49.The use of scleral buckles (SBs) to repair rhegmatogenous retinal detachments (RRDs) was pioneered by Custodis in 1949, with the first reported scleral buckling procedure performed in the United States in 1951 by Schepens. Scleral buckling methods for rhegmatogenous retinal detachment. Radial buckling in the repair of retinal detachment. Metallic clips used for scleral buckling: ex vivo evaluation of ferromagnetism at 1.5 T. Because tantalum is a non-ferrous metal (non-magnetic), these clips are considered to be acceptable for patients undergoing MRI procedures.īakshandeh H, Shellock FG, Schatz CJ, Morisoli SM. Tantalum clips did not cause tissue reaction and did not harbor infection. Tantalum clips were found to be less bulky than sutures, allowing the surgeon to adjust the tension of the circling band for the scleral buckle. Some metallic clips may pose a risk to patients undergoing MRI procedures. In rare instances, a metallic clip may be used. The encircling band is usually a thin silicone band sewn around the circumference of the sclera of the eye. Scleral buckles come in many shapes and sizes. ![]() This procedure effectively holds the retina against the sclera until scarring seals the tear and prevents fluid leakage, which could cause further retinal detachment. The buckle effect may cover only the area behind the detachment or it may encircle the eyeball like a ring. This buckling effect on the sclera relieves the traction on the retina, allowing the retinal tear to settle against the wall of the eye. ![]() The element pushes in, or “buckles,” the sclera toward the middle of the eye. The buckling element is usually left in place permanently. The application of a scleral buckle (note, this is a procedure not an implant) or "scleral buckling" is a surgical technique used to repair retinal detachments and was first used experimentally by ophthalmic surgeons in 1937.īy the early 1960s, scleral buckling became the method of choice when the development of new materials, particularly silicone, offered surgeons new opportunities for improving patient care.
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