SCLERAL Buckling DR AJAY DUDANI

Presenting author:- Dr. Kanchan Bala Rathore
Senior Resident
Taparia Institute of Ophthalmology
Bombay Hospital
Chief author:- Dr. Ajay Dudani
Eye Advance 2016 (17th - 19th June) Renaissance Convention Center Hotel - Mumbai

The author(s) have no financial interest in any
materials discussed in this presentation

RHEGMATOGENOUS RETINAL DETACHMENT

 The fundamental principles of retinal attachment surgery are same since
the popularization of scleral buckling techniques by Charles Schepens and
others in the early 1950s.
 Specifically,
o All retinal breaks are identified and treated
o Vitreous traction

 The most common re-attachment procedures performed
today are :
o Scleral buckling (SB)
o Pars plana vitrectomy (PPV)
o Pneumatic retinopexy (PR)

IN THECURRENT SCENARIO SCLERAL
BUCKLING IS
QUIETLY GETTING OUT OF TREND……

 To describe outcome of scleral buckling as a treatment for
Rhegmatogenous Retinal Detachment .

 STUDY DESIGN: Retrospective case series
 PLACE OF STUDY: Taparia institute of ophthalmology -Bombay
Hospital and Mumbai Retina Centre.
 STUDY POPULATION: The study included 50 eyes of 50 patients
between the age group of 18 to 68 years.
 STUDY PERIOD: One Year.

INCLUSION CRITERIA
Cases of fresh Rhegmatogenous RD
EXCLUSION CRITERIA
Cases of RRD with PVR Grade C
Giant retinal tears
 Posterior break
RRD with vitreous hemorrhage
 RRD with choroidal detachment
 Patients with any previous RD surgery

 Preoperatively extensive fundus drawing was
made to localize tear /hole, number and
presence of PVR.
 Surgery was performed under peribulbar
anesthesia with mild sedation.

 In this case series, all patients underwent technique of :
 Break localization
 Cryotherapy of breaks
 Encirclage with silicon 240 band
 Localized 279 scleral buckle
 Sub-retinal fluid drainage by 26 number gauge needle
 Gas (C3F8) was used for temporary pneumatic retinopexy
 Intraoperative laser was done to augment chorioretinal
adhesions for new breaks.

 Immediately after the surgery, retina was reattached in 45 eyes.
SUCCESS RATE
90%

0
5
10
15
20
25
30
6/9 to 6/6 6/9 to 6/18 6/24 to 6/36 6/60 to CF HM
Presenting VA
Post op VA

 5 patients underwent vitrectomy with silicon oil for recurrent detachment.
 Two patients underwent vitrectomy for epiretinal mambrane and macular
pucker.
 Sub retinal bleed was seen in 3 of our patients.
 Post operative vision remained unimproved in 2 eyes.
 Post operative lid edema was seen in 10 patients.

 Scleral buckling is a very effective procedure in cases of uncomplicated
RRD patients*.
 Unfortunately, this technique is performed less frequently due to the
introduction of PPV in early 1970s.
 However, SB has multiple advantages over PPV
*Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery
in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand. 2007;85:540–545.

INTRAOPERATIVE PPV SB
Relieve of VR traction Direct Indirect
Location of breaks Effective for superior breaks No preference
SRF drainage Internal External
Post op positioning Required Not required
Post op pain Less Generally more
Surgical costs Higher Lower
Advantages Clears vitreous opacities
Giant retinal tears
Supports missed breaks
Allows early air travel
Potential complications New retinal breaks
Elevated IOP from gas bubble
Retinal or optic nerve trauma
Induced cataract
Retained liquids
Refractive change
Endopthalmitis
Retinal incarcerations
Refractive changes
Motility disturbances
Suprachoroidal or sub retinal
haemorrage
Retinal incarceration
Buckle related complications

SCLERAL BUCKLING PARSPLANAVITRECTOMY

Specific indications of scleral buckling are :-
1) Less risk of cataract formation, making it suitable for young patients.
2) In older patients , vitreous in preserved.
3) In Myopes with extensive lattice degeneration or an abnormal vitreoretinal
interface, scleral buckling provides 360 degree support of vitreous base and
peripheral retina.
4) Furthermore, in certain cases like retinal dialysis, SB is the treatment of
choice, with a better prognosis and success rate. [*]
*James M, O'Doherty M, Beatty S. Buckle-related complications following surgical repair of retinal dialysis. Eye (Lond)
2008;22:485-90.

TAKE AWAY MESSAGE….
Scleral buckling is a :-
Simple
Effective
Less time consuming
Less expensive technique
Better long term visual rehabilitation
It’s a backbone of RD surgery
Save it from becoming a lost art.

SCLERAL Buckling DR AJAY DUDANI

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