Author: Diogo Matos (Portugal)
Co-authors: Rafael Barão, Patrícia José, Pedro Gomes, Rui Ferreira, Nuno Ferreira, Mun Faria
Purpose
Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment occurring in about 1 in 10,000 people a year. (1) The ideal procedure involves break closure with minimum trauma and maximum primary retinal attachment. Long-term success and functional results depend on technique and patient-related conditions. In the last few decades, primary PPV has been the method of choice to manage RRD but it may not be the best suited procedure for every patient. (2) (3) (4) Scleral buckling (SB) offers a minimally invasive solution to treat RRD and is usually preferred in the context of isolated retinal break, young phakic patients and absence of Vitreo Retinal Proliferation (VRP) (5)
Setting/Venue
All surgeries were conducted at the Ophthalmology Department of Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte (HSM - CHULN), Lisbon, Portugal, with explicit informed consent and following the Portuguese medical legis artis.
Methods
Case-series description of the surgical technique used for minimally invasive surgery in the setting of RRD. Patients underwent minimally invasive retinal detachment surgery at HSM-CHULN between April 2020 and November 2020. Preoperatively, all the patients underwent a complete ophthalmologic examination including assessment of best-corrected visual acuity (BCVA), Goldmann® tonometry and standard fundus dilated ophthalmic examination. All patients underwent surgical repair upon a week after holes or retinal tears were identified. A circular scleral buckling with scleral tunnels was performed and cryotherapy was applied ab externo to the areas of retinal tears, under direct visualization with an endoilluminator (Alcon® Laboratories, FW, TX) through a BIOM®5 microscope system (OCULUS® Surgical, Inc., FL, USA) coupled with a surgical microscope (Zeiss® OPML Lumera T). No further drainage or tamponades were performed.
Results
A total of 6 eyes of 4 patients underwent this procedure. The surgery was performed under direct visualization with a 25-G endoilluminator intraoperatively. All patients presented with inferior detachment, either with macula on or with macula off, and all patients presented good retinal apposition upon surgical completion and maintained this result through serial ophthalmologic examinations. Residual subretinal fluid was reabsorbed in the first 24 hours postoperatively as observed by fundus examination combined with Optic Coherence Tomography (OCT), which also showed anatomical chorioretinal apposition in every patient enrolled in this study. Upon 6 months follow-up, all patients maintained anatomical chorioretinal apposition and presented an improved best-corrected visual acuity (BCVA) when compared to the pre-operative status. No patient developed cataract or ocular hypertension during the 6-month follow-up so far.
Conlusions
Scleral buckling is still an important procedure in selected eyes, producing good visual outcomes. When combined with recent technologies such as endoilluminators, it may provide an optimal control over chorioretinal apposition and cryotherapy application delivery, therefore avoiding the need for PPV and its most common complication in phakic eyes.
Financial Disclosure
There are no conflicts of interest to report
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