10/28/2023 0 Comments Scleral buckle surgery![]() ![]() In the USA, scleral buckling was also being developed by Charles Schepens, who deployed a polyethylene encircling tube and drained subretinal fluid along with diathermy. He reported his technique with a consecutives series of 515 patients with an 83.3% rate of success-a figure that compares favourably with many series being published 50 years later. Custodis introduced a polyviol explant to buckle the sclera, breaks were treated with diathermy and a non-drainage procedure was used. Whilst the scleral shortening techniques were being elaborated, in 1949, Ernst Custodis developed an explant specifically to produce a buckling effect for retinal detachment repair whilst circumventing the risks associated with scleral shortening and resection (Fig. With all of these techniques, the main objective was the ‘buckling’ effect that was produced, which became a key factor in successful retinal re-attachment. These techniques included Weve’s ‘reefing’ procedures, scleral out-folding procedures, scleral in-folding procedures and scleral shortening by shrinkage with diathermy. However, even lamellar resection carried a high risk of comorbidity and attempts to achieve the same buckling effect without risking tissue resection were therefore developed. The area of the resection often resulted in a buckling effect, and attempts were made to localise the resection site over the break, in order to aid retinal re-attachment. Full thickness scleral resection was then refined to lamellar scleral resection in 1949 by Shapland to decrease the ocular complications from scleromalacia-a common association with rhegmatogenous retinal detachment. It was subsequently realised that as a result, this actually brought the retinal pigment epithelium and neurosensory retina together, assisting retinal re-attachment. Scleral buckling surgical techniques originally evolved from scleral resection which was initially developed to reduce the size of the eyeball or as an attempt to strengthen the sclera and prevent stretching. Since then, many different techniques have been developed to treat retinal breaks, but this article focuses particularly on the roles of scleral buckling. ![]() A common belief in his era was that retinal breaks were either not present or were otherwise secondary to retinal detachment. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.Īny attempt to summarise the history of retinal detachment repair must begin with Jules Gonin’s pioneering observation that accurate localisation and sealing of the retinal break(s) was the key to successful re-attachment. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. Scleral buckling is not a one-size-fits-all technique. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV).
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