Retina Today - Retina Pearls: Scleral Buckling for Rhegmatogenous Retinal Detachment (September 2011)

摘要

In this issue of Retina Today, Andres Amaya Espinosa, MD; Gina Baron Mendoza, MD; Maria Alejandra Toro Millan, MD; and Natalia Camacho Espinosa, MD, provide surgical pearls for performing scleral buckling for rhegmatogenous retinal detachment as an alternative to vitrectomy in uncomplicated cases.. We extend an invitation to readers to submit pearls for publication in Retina Today. Please send submissions for consideration to Ingrid U. Scott, MD, MPH (iscott@psu.edu); or Dean Eliott, MD (dean_eliott@meei.harvard.edu). We look forward to hearing from you.a??Ingrid U. Scott, MD, MPH; and Dean Eliott, MD Rhegmatogenous retinal detachment (RRD) has been managed by several methods, from pneumatic retinopexy to pars plana vitrectomy (PPV). Scleral buckling, however, remains the surgical procedure of choice for RRD without proliferative vitreoretinopathy (PVR).1 In 1929, Jules Gonin, MD, postulated that a retinal break was the cause of RRD; he limited treatment by surrounding the area of the break after drainage of subretinal fluid. With this procedure, he attained a 57% reattachment rate.2 Gustav Guist, MD; and Karl Lindner, MD, applied multiple scleral trephines posterior to the estimated position of the break, which raised their reattachment rate to 70%.2 Eleven years later, Bengt Rosengren, MD, added an air tamponade, and the bubble was positioned in the area of the break. Subsequently, the reattachment rate increased to 77%.2 During the 1950s, Charles Schepens, MD, introduced the circular buckle, which represented a maximum barrier for the leaking break with extensive coagulation to secure the anterior retina. With this technique, more than 80% of retinas were reattached.3 In 1960, Harvey Lincoff, MD, replaced diathermy with cryopexy, diminishing complications and increasing the anatomical success to more than 88%.3 With rapid advances in instrumentation and the improved success rates of vitrectomy, there has been a growing trend towards the use of primary vitrectomy for RRD without PVR.4 We present several cases of primary RRD that were treated with scleral buckling and cryopexy. Drainage of subretinal fluid and pneumatic retinopexy were also performed in some patients. Technique Our technique begins with a 360?° peritomy. Rectus muscles are repaired and indirect ophthalmoscopy is performed to locate the retinal break. Then a scleral incision is created for drainage of subretinal fluid, which is performed in cases of bullous retinal detachments or inferior detachments. Once the drainage is done, cryopexy is achieved in the exact location of the break. To finish the procedure, a band is placed at 360?°, inducing an appropriate indentation. If the break is in the superior quadrants, C