A thirty-six years old patient presented with inferotemporal chronic retinal detachment involving the macular area for only two days. Retinal detachment was due to multiple atrophic holes in the periphery, with clear lens, no posterior vitreous detachment and laser treatment in peripheral predisposing lesions. The patient underwent scleral bucking surgery in the other eye several years ago. We decided to perform scleral buckling surgery with a band and circumferential explant because the patient presented with 360º pathology in the periphery retina and had multiple holes in the area of the detachment from the ora serrata to the equatorial zone. Given the need to treat all holes and locate accurately the explant, surgery was performed with chandelier light using Binocular Indirect Ophthalmo Microscope (BIOM) system visualization. A 360º peritomy with slinging of all four rectus muscles were performed. The posterior retinal holes were marked indenting with curved diathermy probe. A scleral band with scleral tunnels and a circumferential tire explant in the inferotemporal sector were placed. The inferior detachment had chronic subretinal fluid and it was too high to reach retinal holes with cryotherapy probe, so drainage of most subretinal viscous fluid was performed by 30 g needle puncture under BIOM control. After this, cryotherapy was applied on the holes in the inferotemporal sector and the scleral buckle was tightened to achieve proper indentation. Conjunctiva was closed with 8-0 polyglycolic acid sutures. Retina was completely attached in a week and no complications were registered on follow up. Visualization with BIOM and chandelier light can be helpful to place quickly and accurately the explant and to drain subretinal fluid in scleral buckling surgery when we have multiple posterior breaks. Besides it makes buckle surgery, easier, ergonomic and it facilitates fellows teaching.

Contact Details:

Email: druizcasas@hotmail.com