Advantages:

Sutures are required to anchor scleral implants during scleral buckling procedure for management of retinal detachment. Suturing of buckle elements is associated with several complications including:

1) Needle Perforation (leading to intra-ocular bleed, retinal breaks, choroidal hemorrhage, softening of globe and change of surgical plan),

2) Premature loosening of suture (leading to anterior migration of buckle and failure of surgery),

3) Late loosening of suture (leading to unsightly bulge, extra-ocular muscle imbalance and buckle erosion),

4) Suture erosion (which may be trans scleral or trans conjunctival) and

5) Buckle infection.

Sutureless anchoring of scleral implants is desirable to minimize wound and suture related complications. More over it may lead less post-operative discomfort, faster rehabilitation and early healing. This will also help in reducing intra-operative time.

Methods:

Retrospective review of 108 eyes that underwent sclera buckling by the sutureless technique from April 2009 to December 2012 was performed. 360-degree fornix based flap is made and all the 4 recti muscles were tagged. Retinal break was localized and marked. Trans sclera cryopexy is done around the breaks. Two radial incisions of 7-8 mm in length were made on both sides of the break. A partial thickness sclera tunnel was made. Encircling tire of an appropriate size is placed in the tunnel. Smaller sclera tunnels (2.5 mm) are made in the other quadrants for the encircling band. The encircling band is passed below the sclera tunnels in all quadrants and the ends are tied using a silicone sleeve. Drainage of the sub retinal fluid is done. Encircling band is tightened to adjust buckle height.

Safety:

Retinal attachment was achieved in 101 out of 108 eyes (94%) by single procedure. Complications observed were scleral perforation (1 eye), post-operative choroidal detachment (4 eyes), cystoid macular edema (3 eyes), residual sub retinal fluid needing 2nd surgery (4 eyes), Proliferative vitreo-retinopathy (3 eyes), epiretinal membrane (1 eye) and macular hole (1 eye). Average intra-operative time was 42.6 minutes. None of the patients had reported for buckle erosion or infection in the post-operative follow up period.