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Novel techniques in scleral buckling.

P Mahesh Shanmugam1, Rajesh Ramanjulu1, K C Divyansh Mishra1

  • 1Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India.

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Summary

Scleral buckling (SB) effectively treats rhegmatogenous retinal detachments (RRD). This guide offers practical tips to overcome surgical challenges, enhancing the learning curve for this established procedure.

Keywords:
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Area of Science:

  • Ophthalmology
  • Surgical Techniques

Background:

  • Scleral buckling (SB) has been a successful treatment for rhegmatogenous retinal detachments (RRD) for over 60 years.
  • Pars plana vitrectomy (PPV) is increasingly favored for RRD, leading to reluctance in performing SB due to perceived difficulty and ergonomic issues.

Purpose of the Study:

  • To provide practical tips and surgical techniques to overcome challenges associated with scleral buckling for RRD.
  • To facilitate the learning process for surgeons regarding scleral buckling.

Main Methods:

  • Discussion of surgical challenges in four key areas: break localization, retinopexy, buckling, and subretinal fluid (SRF) drainage.
  • Exploration of techniques such as using forceps or illuminated scleral depressors for break localization.
  • Introduction of alternative methods like sutureless and suprachoroidal buckling, and modified SRF drainage techniques.

Main Results:

  • Specific methods are detailed for easier break localization, including using chandeliers and prior SRF drainage.
  • Sutureless and suprachoroidal buckling are presented as faster alternatives to conventional SB.
  • Modified techniques for SRF drainage (needle, laser choroidotomy, infusion-assisted) are described to improve safety and ease.

Conclusions:

  • The article provides practical guidance and detailed illustrations to simplify the learning and execution of scleral buckling for RRD.
  • Adoption of these techniques can help overcome the perceived steep learning curve and improve surgical outcomes for RRD repair using SB.