Chandelier-Assisted Scleral Buckling: A Literature Review

Governatori, Lorenzo; Scampoli, Alessandra; Culiersi, Carola; Bernardinelli, Patrizio; Picardi, Stefano Maria; Sarati, Federica; Caporossi, Tomaso

doi:10.3390/vision7030047

Vision

2023

DOI: 10.3390/vision7030047

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Chandelier-Assisted Scleral Buckling: A Literature Review

Lorenzo Governatori,

Alessandra Scampoli,

Carola Culiersi

et al.

Abstract: The treatment of retinal detachment (RD) has seen numerous advancements in the last decades. Scleral buckling (SB) is a surgical procedure introduced in the 1950s that has seen a drastic reduction with the advent of vitrectomy. However, due to the new surgical visualization systems, SB has evolved and continues to be an extremely useful procedure in certain conditions. The presence of different case reports or interventional studies with comparable outcomes, as well as the lack of recent studies with direct co… Show more

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2024

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Cited by 2 publications

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Acute infectious endophthalmitis after chandelier-assisted scleral buckling surgery

Choudhary,

Hande,

Gandhi

et al. 2024

European Journal of Ophthalmology

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Purpose To report a rare case of acute bacterial endophthalmitis that developed after scleral buckling surgery performed with non-contact wide-angle viewing system (WAVS) and chandelier endoillumination. Case description A 63-year-old man underwent scleral buckling surgery using a WAVS with chandelier endoillumination for rhegmatogenous retinal detachment repair in his left eye. Seven days after the surgery, the patient noticed a marked decrease in his vision with ocular pain. No anterior chamber inflammation or exudates were found. No focal congestion or exudates were noted at the sclerotomy site. Posterior segment examination revealed severe vitreous haze and yellowish exudates in the vitreous cavity. Ocular ultrasound revealed dense vitritis, complete posterior vitreous separation, a fully attached retina, and a peripheral scleral buckle indent. Vitreous biopsy combined with pars plana vitrectomy with intravitreal antibiotic injections was done immediately, and Staphylococcus epidermidis was detected in the vitreous fluid. Following surgery, the inflammation and infection subsided and the visual acuity recovered to 6/9 in 6 weeks. Conclusion Infectious endophthalmitis is a rare occurrence after chandelier-assisted scleral buckling (SB) surgery, characterized by ocular pain and a sudden decline in vision as key symptoms. Clinicians should be cognizant of the possibility of its occurrence following SB surgery, especially when utilizing the WAVS with chandelier endoillumination.

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Acute infectious endophthalmitis after chandelier-assisted scleral buckling surgery

Choudhary,

Hande,

Gandhi

et al. 2024

European Journal of Ophthalmology

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Operative Times in Scleral Buckle Surgery: Influencing Factors and Cost Analysis

Blumenthal,

Meshkin,

Hoyek

et al. 2024

Journal of VitreoRetinal Diseases

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Purpose: To determine the various factors affecting the duration of scleral buckle surgery, the percentage of profitable scleral buckle cases, and the operational break-even point. Methods: This single-center retrospective consecutive series comprised patients diagnosed with primary rhegmatogenous retinal detachment (RD) repaired with scleral buckling between 2019 and 2021. The primary outcome was operative time. Factors associated with longer surgery time were identified using regression analysis. A time-driven activity-based cost analysis was performed. Results: Following are the mean values: duration of 108 primary RD scleral buckle repairs, 106 ± 35 minutes (range, 52-231; median, 98); number of breaks, 2.15 ± 1.5 (range, 0-10); extent of the RD, 4.3 ± 2.0 clock hours (range, 0-9); duration of follow-up with a retina physician, 489 ± 355 days (range, 0-1316). Twenty eyes (19%) required subsequent RD repair. A regression analysis showed the following main risk factors for prolonged duration of RD repair via scleral buckling: number of breaks (β = 5.98; P = .005), use of radial elements (β = 52.09; P = .001), and gas injection (β = 31.27; P < .001). The median cost per case was $7674.64, which was $2713.64 (55%) more than the maximum Medicare reimbursement of $4961.00. The break-even time was 54.43 minutes. Conclusions: Independent risk factors for a prolonged duration of primary scleral buckle surgery include multiple breaks, use of radial elements, and gas injection. These additive steps could justify a separate complex Current Procedural Terminology code. The large majority of cases were not profitable, with losses proportional to operative time. This study demonstrates the clear need for greater reimbursements and economic incentives for scleral buckle surgery.

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Chandelier-Assisted Scleral Buckling: A Literature Review

Cited by 2 publications

References 40 publications

Acute infectious endophthalmitis after chandelier-assisted scleral buckling surgery

Acute infectious endophthalmitis after chandelier-assisted scleral buckling surgery

Operative Times in Scleral Buckle Surgery: Influencing Factors and Cost Analysis

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