who assisted with the development of the analytic plan and concept development. Dr Ellis was not compensated.

The burden of disease in diabetes eye care has reached gargantuan proportions in the 21st century. There are an estimated 552 million people globally who will live with diabetes by the year 2030, with half of this population eventually developing diabetic retinopathy. 1 As such, we are approaching a landmark in history where radical changes in the way we practice ophthalmology will be required to maintain delivery of high quality care to these patients. The examination of the human retina was only made possible in 1851, when Hermann von Helmholtz first held up a lens to a patient's eye using a naked candle as a source of illumination. 2 To this day, ophthalmologists round the world use the same physical principles to perform a retinal examination. The evolution of the ophthalmic examination has occurred in a gradual step-wise fashion, following the developments of its time; for example, the invention of electricity allowing for more powerful light sources, and modern optical lenses that offer a wider field-of-view of the retina. However, it has been the more recent exponential leaps in digital technology that 629983D STXXX10.

Aim The use of adjunctive scleral buckling during vitrectomy for retinal detachment associated with inferior breaks has been the recent focus of some debate. It has been suggested that any benefit might be outweighed by potential complications associated with buckling surgery. The purpose of this study was to compare the success rate of vitrectomy, gas, and supplementary scleral buckling with the results of two recently published case series suggesting that acceptable results in inferior break detachments can be achieved with vitrectomy and gas alone. Methods A retrospective analysis of 60 consecutive patients with inferior break retinal detachments was conducted. All patients underwent vitrectomy, gas, and scleral buckling. In all cases, fellow eyes were examined under anaesthesia for retinal breaks if posterior vitreous detachment (PVD) had occurred at the time of presentation. Demographics, preoperative, and postoperative complications and outcome were recorded. Results Primary retinal attachment at 3 months was achieved in 95% of patients. This exceeds success rates of published data of patients who underwent vitrectomy and gas without buckling (81-89%). In patients with PVD in the fellow eye, 53% had horseshoe tears and all were treated with cryopexy. No sight-threatening complications occurred, but five patients developed minor buckle-related complications postoperatively. ConclusionSupplementary scleral buckling is a safe procedure that improves and enhances primary success rates in inferior break detachments over vitrectomy and gas without buckling. There is a high rate of PVDrelated breaks requiring treatment in the fellow eyes.