Chandelier-Assisted Versus Standard Scleral Buckling for Primary Rhegmatogenous Retinal Detachment

Abstract

Purpose: To compare anatomical outcomes, functional outcomes, and rate of complications of standard scleral buckling (SSB) versus chandelier-assisted scleral buckling (CSB) in phakic eyes with rhegmatogenous retinal detachment.Methods: Patients were randomly assigned to either SSB or CSB. Surgical success/ failure rate, corrected distance visual acuity, surgical operating time, and rate of intraoperative and postoperative complications including epiretinal membranes by spectral domain optical coherence tomography were compared between groups.Results: A total of 50 eyes of 49 patients were included. At 6 months, there was no statistically significant difference between groups in primary success, or final anatomical success (P . 0.9); mean corrected distance visual acuity at any visit (P values .0.05); or mean surgical time: 120.3 ± 39.05 and 102.48 ± 43.76 minutes for the SSB and CSB, respectively (P = 0.1). The CSB had a higher rate of postoperative complications (34.8%) compared with the SSB (3.8%) (P , 0.05). On spectral domain optical coherence tomography, CSB had a statistically significant higher rate of epiretinal membranes compared with SSB (44% vs. 19% [P , 0.05]) and showed vitreous entrapment in the chandelier sclerotomy site on the ultrasonic biomicroscopy.Conclusion: Chandelier-assisted scleral buckling surgery does not offer encouraging advantages over SSB. On the contrary, we detected a higher rate of complications with CSB especially epiretinal membranes development.

Outcomes of Chandelier-Assisted Scleral Buckling in Rhegmatogenous Retinal Detachments: Systematic Review and Meta-analysis

“…2,8,18,24 Six studies reported this complication, with incidences ranging from 5% to 48%. 2,8,10,18,24,30 Sutures at the sclerotomy site were also needed in some of the reported cases. 10,30 Authors have proposed methods to reduce the risk for vitreous prolapse, including using valved cannulas, paracentesis, or subretinal fluid drainage to lower IOP before trocar removal; inserting the trocar obliquely; or plugging the cannula during episcleral procedures as well during removal of the trocar.…”

“…1 Scleral buckling is often performed in younger, phakic patients who have an attached posterior hyaloid because it allows for preservation of the vitreous. 2 In addition, cataractogenesis is less likely to occur with scleral buckling than with PPV, making scleral buckling more palatable for the patient. [2][3][4] However, compared with PPV, scleral buckling has disadvantages of longer operative times, a more difficult learning curve, and a higher risk for missing additional retinal breaks.…”

“…2 In addition, cataractogenesis is less likely to occur with scleral buckling than with PPV, making scleral buckling more palatable for the patient. [2][3][4] However, compared with PPV, scleral buckling has disadvantages of longer operative times, a more difficult learning curve, and a higher risk for missing additional retinal breaks. 1,2 In standard scleral buckling, an indirect ophthalmoscope is typically used to view the retina.…”

“…[2][3][4] However, compared with PPV, scleral buckling has disadvantages of longer operative times, a more difficult learning curve, and a higher risk for missing additional retinal breaks. 1,2 In standard scleral buckling, an indirect ophthalmoscope is typically used to view the retina. It generates an inverted image and can be tedious to wear and remove repeatedly.…”

Rhegmatogenous retinal detachment surgery: A review

“…As this has become more readily accessible to surgeons there has been increasing literature to support its non‐inferiority to standard indirect viewing. To date, chandelier assisted scleral buckle repair has shown primary reattachment rates ranging from 78% to 95% which is at least equally favourable to our conventional repair methods 44–46 . Unfortunately, more data are needed to see if the possible complications from disturbing the vitreous (i.e., prolapse and iatrogenic breaks) may make this technique less advantageous than it would appear.…”