Scleral Buckling for Retinal Detachement Surgery Not to Be Disclaimed

Scleral Buckling for Retinal Detachement Surgery Not to Be Disclaimed

Lidmila Prochazkova, Martina Zavorkova (Usti nad Labem, Czech Republic)

Advantages:

Cryosurgical approach, relying on cerclage and buckling, still bears considerable benefits. The lens does not blur as an effect of the pars plana vitrectomy (PPV) and at the same time no other surgical intervention (i.e. removal the silicone oil) is necessary. Due to blurring of lens after vitrectomy, this external approach is suitable especially for younger people with well-preserved eye accommodation.

Methods:

Within 5 years (1/2005 to 12/2009) our department performed 265 surgeries of retinal detachment, out of which 26 (9,8%) were carried out by external approach and 239 (90,2%) by PPV. The age of patients treated ranged from 22 to 81 years, mean 56,8 ± 14,2 years. 20 patients had their own lens and 6 patients an intraocular lens, predominantly silicone. The detachment was 11x (42,3%) localized in 1 quadrant, 12x (46,2%) in 2 quadrants and 3x (11,5%) in 3 quadrants. Among the findings the most common was 1 tear or hole – 22x (84,8%). In 20 cases (77%) the retina turned out to be attached straight after the surgery, while in 6 cases (23%) the surgery had to be performed again. In 5 patients treated repeatedly we managed to attach the retina, thus in 25 patients (96,2%) the surgery proved successful and in 1 patient (3,8%) the retina remained detached.

Effectiveness / Safety:

In 25 patients (96,2%) the retina has been attached. Functional outcomes reported: good VA 6/6 – 6/18 in 61,5% patients, usable VA 6/24 – 6/60 in 34,6% patients. The anatomical outcomes match the functional outcomes, which is quite rare. The scleral buckling is suitable mainly for younger people with their own lens and preserved eye accommodation. Another suitable indication for this approach is smaller retina detachment with a single tear or hole.

Take home message:

Due to blurring of lens after vitrectomy, this external approach is suitable especially for younger people with well-preserved eye accommodation.