A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization

Abstract

The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP). Methods: A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16). Results:The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0-0.20) in the ID group and 0.08 (0.02-0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94-123) minutes in the ID group and 100 (90-111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100-135) minutes vs 93 (85-111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group. Conclusion:Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.

Heads-up 3-Dimensional Visualization to Enhance Video Endoscopy During Vitreoretinal Surgery

“…19,[26][27][28] More retrospective comparative studies with larger samples across a variety of surgical cases as well as a prospective multicenter study would be helpful in evaluating how ophthalmic endoscopy affects surgical decisionmaking, operative time, education, and visual and anatomic outcomes. Some studies have suggested that 3D visualization decreases case duration and improves outcomes compared with tradi tional microscopic surgery, [11][12][13][14] while other comparative studies found similar outcomes but no significant differences. 53 A comparative study of endoscopy performed on a separate 2D monitor vs integrated in a splitscreen view with headsup 3D visualization is needed to confirm the potential advantages.…”

“…First reported in 2009, 10 headsup 3D surgery has improved ergonomics and educational value and at times has decreased case duration. [11][12][13][14] Another advantage of the headsup 3D system is the ability for simultaneous viewing with a splitscreen image, such as during cases involving intraoperative optical coherence tomography (OCT) or video endoscopy. 15,16 We present 2 cases of simultaneous headsup 3D visualiza tion with concurrent ophthalmic endoscopy and discuss the clinical indications for ophthalmic endoscopy and its future directions.…”

Modified Endolaser Instrument for Chandelier Scleral Buckling

“…Although endolaser use has been reported during chandelier scleral buckling, the main concern has always been the potential for vitreoretinal traction and subsequent iatrogenic retinal breaks caused by excessive transit of the probe through the vitreous cavity. 4,7 The 20 mm offset sleeve of our modified instrument was chosen after measuring its combination with a valved trocar to limit its penetration into the vitreous to the same distance as the standard chandelier (Figure 1B). This provides the surgeon with a shortened illuminated probe to target the breaks, minimally invading the formed vitreous with no greater risk for traction on the vitreous base than that created by a standard chandelier.…”

Chandelier-Assisted Scleral Buckling: A Literature Review

“…The traditional scleral buckling group had no post-operative problems, but the 3D with a guarded light pipe (3DGLP) group experienced one self-resolving vitreous hemorrhage issue linked to a broken cryoprobe ( p = 0.34). In neither group were there any instances of post-operative cataract advancement [ 39 ].…”