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Common Vitreoretinal Procedures
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Macular buckling, first described by Schepens, is now being resurrected as an effective procedure to treat patients with complications of MTM. Silicone is the dominant material used, and several shapes have been marketed [L, T, quadrangular, circular]. Some of these have wires to allow the buckles to be molded into a desirable curvature [Ando-stainless steel], while others have optical fibres to facilitate visualization of buckle location [AJL Ophthalmic, Spain]. Surgical steps are identical to that during scleral buckling surgery using a segmental buckle [with limited peritomy]. The most important steps during surgery include safe passage of posterior scleral suture and precise localization. The latter is commonly detected using an indirect ophthalmoscope; however, internal illumination using a chandelier light [similar to EASB] and wide-angle viewing may be more effective. Macular buckles with inbuilt illuminated optical fibre also improve the outcome of surgery by allowing precise localization. In addition to complications similar to those that could occur during scleral buckle surgery [particularly with drainage], macular buckle surgery has added risks like compression of the optic nerve and damage to vortex veins. A third approach claimed in some small case series has having higher success is pars plana surgery combined with macular buckling. Owing to lack of appropriate guidelines, the surgeon must individualize each case and discuss the objectives, anticipated intraoperative challenges, risks, and unpredictable and delayed positive impact on visual recovery and stability.
Vitreoretinal
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
There is variation among surgeons on which surgery to choose. For simplicity: Vitrectomy: Most commonly used procedure, indicated for posterior retinal breaks, giant retinal tears and proliferative vitreoretinopathy.Scleral buckle: Very high success rate. Used in simple RRD and retinal dialysis when there is no pre-existing PVD.Pneumatic retinopexy: Lower success rate but also fewer side effects; used in carefully selected cases with small superior breaks 1 clock hour apart between 11 and 1 clock hours.
Removal of intraocular foreign bodies
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
William J Wirostko, Sumit Bhatia, William F Mieler, Cathleen M McCabe
Magnetic IOFBs located both anterior to the equator and in the subretinal or intraretinal space can be removed through a scleral cutdown (Fig. 49.5). This involves extracting the IOFB through a T-shaped scleral and uveal incision with an external magnet. A flap should be created after indirect ophthalmoscopy has localized the IOFB, and diathermy should be applied to the surrounding uveal bed to limit the risk of hemorrhage. Transpupillary laser photocoagulation retinopexy may be placed around the IOFB site. Both treatments are best placed prior to transuveal passage, because hemorrhage may limit further treatment. After extraction is complete, the sclerotomies are sutured closed. A scleral buckle may be placed, especially if the retina is incarcerated in the wound.
Anatomic Outcomes and Prognostic Factors of Vitrectomy in Patients with Primary Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment
Published in Current Eye Research, 2019
Yajie Yu, Yankun Yue, Nianting Tong, Pengfei Zheng, Wu Liu, Ming An
Rhegmatogenous retinal detachment associated with choroidal detachment ((RRDCD) is a special form of RRD associated with choroidal and ciliary body detachment. RRDCD is characterized by its rapid progression, poor prognosis, and difficult treatment.1–4 In a previous study, we found that hypotony, posteriorly located retinal breaks (especially macular holes), longer axial lengths, and whole retinal detachments may be potential risk factors for the development of RRDCD.3 The prognosis of the conventional scleral buckle surgery, with or without drainage of the suprachoroidal fluid, is unfavorable because of delayed diagnosis, the poor retinal reattachment rates with scleral buckling, and the high incidence of postoperative proliferative vitreoretinopathy (PVR).2,5,6 However, encouraging outcomes have been obtained with primary vitrectomy.7–10 The results of previous studies demonstrate that although higher retinal reattachment rates could be expected following single or multiple vitrectomies in most patients, the retinal reattachment rate and visual acuity (VA) outcome after vitrectomy are not ideal in patients with RRD. The present study analyzed in depth the anatomic outcomes and prognostic factors of vitrectomy in 175 patients with primary RRDCD in the Beijing Tongren Hospital as a retrospective review using a large case series.
Oral mucosa grafting in periorbital reconstruction
Published in Orbit, 2018
Scleral explant exposure may occur following retinal detachment surgery secondary to atrophy of the overlying tissues and conjunctival wound dehiscence. Removal of the scleral buckle is associated with an increased risk of retinal re-detachment particularly in the presence of continuing vitreoretinal traction, proliferative vitreoretinopathy, a history of multiple retinal reattachment procedures or aphakic patients with multiple post-oral retinal breaks.64–67 In such patients, it is preferable to retain the exposed scleral explant and cover it with a banked scleral patch graft. An autologous OMG can then be used as a conjunctival substitute to lie over the scleral graft.22 This is primarily useful in patients who possess unhealthy and scarred conjunctiva secondary to multiple retinal procedures including cryotherapy. Murdoch et al.22 successfully managed exposed silicone retinal explants in 4 patients with this technique. The graft survived and the explant remained covered in all cases at 11 months follow-up.
Complications Assoicated with MIRAgel for Treatment of Retinal Detachment
Published in Seminars in Ophthalmology, 2018
Miin Roh, Nahyoung Grace Lee, John B. Miller
Scleral buckling was first reported by Jess in 1937 and refined by Schepens1 in 1957 to seal off the retinal break by externally pushing the diathermized choroid to the detached retina. This external compression of the globe by the scleral buckle creates a permanent indentation of the eye wall, bringing the detached retina closer to the RPE and sclera. Polyethylene tubing has advantages, such as the ability to regulate the height of the ridge, as well as being a medium for antibiotic suspension, possibly decreasing the rate of late infections. However, this material was soon abandoned as a result of the small diameter size, chronic infections secondary to the non-absorbable suture in the tube’s lumen, and scleral erosion.2 Since then, several other materials have been utilized for scleral implant, such as solid silicone rubber3 and silicone sponges.4