Modified Scleral Buckling With a Non-Contact Wide Angle Viewing System and a 25g Chandelier Endoillumintor

Abstract

Purpose:To evaluate the outcome of scleral buckling surgery using a wide angle non-contact viewing system and chandelier endoillumination for per-operative fundus visualization in patients with non-complex rhegmatogenous retinal detachments.Materials and Methods:This was a prospective, interventional study carried out at the Department of Ophthalmology, Mayo Hospital Lahore over a period of six months. Non-probability convenience sampling technique was employed. Fifteen eyes of fifteen pati-ents underwent modified scleral buckling procedure for rhegmatogenous retinal detachment using a 25G Awh Chandelier (inserted into the sclera through the pars plana) and wide angle viewing system to view the fundus intraoperatively instead of the conventional Indirect Ophthalmoscope.Results:The mean age of the patients in this study group was 41.9 12.4 years. Out of fifteen patients, 13 had flat retinas postoperatively. Two patients had to undergo pars plana vitrectomy with silicone oil tamponade due to development of retinal detachment secon-dary to PVR.Conclusion:Modified scleral buckling with the con-current use of a chandelier light and wide angle viewing system provides an easier and more convenient means of visualizing the fundus under panoramic viewing conditions intraoperatively.Key Words:Wide angle viewing system. Retinal detachment. Scleral buckling. Endoillumination.

Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure

“…Although similar observations were noted in our group, buckling under the microscope still had its challenges. Jahangir et al [ 21 ] reported difficulty in rotating the globe with the chandelier light in place. Also, Seider et al [ 22 ] noted that the sutures around the muscles did not provide the same control provided with instruments within sclerotomies in PPV.…”

“…Fixing the silicone band to the sclera before inserting the chandelier trocar and cannula could minimize the risk of these complications. This sequence was used by Jahangir et al [ 21 ] and Wang et al [ 28 ] and also by our group.…”

“…In our study, we used number 41 band (Mira Inc., Uxbridge, MA, USA) in all eyes and none needed augmentation by a sponge or a tire. Few chandelier-assisted SB studies had similarly reported using bands as Seider et al [ 22 ] who used number 42 band in 58% of their cases and Jahangir et al [ 21 ].…”

“…In our study, the primary success rate was 83.3% (25 out of 30 eyes) which was comparable to previous reports. The reported overall success rate with conventional SB ranged from 77% to 93% [ 41 ] and with chandelier-assisted buckling ranged from 83.3% to 95.6% [ 21 , 25 – 27 , 42 , 43 ]. The primary objective of our study was to reduce the sources of complication while maintaining the high success rate, which was actually achieved.…”

Modified Hamilton’s Controlled Encircling Procedure for Retinal Detachment

“…A reduction in band length of 10% to 20% its circumference is considered to be safe, 14 yet many of the reported complications can be attributed to overtightening of the strap. During scleral buckling, the desired indentation effect is checked intraoperatively through the use of binocular indirect ophthalmoscopy or other viewing systems, 18 which is an inadequate qualitative approach given that the appearance of the indentation can be misleading. In contrast, the method described here improves application of the scleral buckle by using objective measurements, resulting in a predictable postoperative buckle height and indentation.…”