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    Scleral buckle technique using PPV, laser photocoagulation

    Scleral buckles and vitrectomy are the two main procedures used today to treat retinal detachments, with many surgeons performing a combination of the two.

    Series of fundus photographs of the scleral buckle effect in the periphery of the retina with laser scars overlying buckle and posterior to buckle. (Images courtesy of Margaret Wong, MD)Success rates for these two methods are comparable. Although studies show scleral buckling to be superior for phakic patients1,2 and vitrectomy superior for pseudophakes,2,3,4,5,6,7 I have seen a trend among new surgeons choosing vitrectomy over the gold standard of scleral buckles because the advancements in technology have made the procedure safer and easier to perform.

    I tend to perform more vitrectomies when treating retinal detachments to avoid potential side effects of scleral buckles. However, when necessary, scleral buckles can be beneficial in closing retinal breaks, collapsing the space between the retina and underlying tissue, and re-establishing the anatomical connection between the two. My scleral buckle technique includes a pars plana vitrectomy and laser photocoagulation.  

    Scleral buckle technique

    Patients who are good candidates for the scleral buckle technique are those who are phakic, have myopic retinal detachment, have retinal breaks that are clearly visible with the vitreous still attached, or have trauma cases with dialysis.  

    To perform the scleral buckle, I insert the speculum, and with scissors and forceps, make a 360º degree peritomy. I take down the conjunctiva 360º degrees around the cornea at the limbus to isolate the sclera.

    I expose the sclera 360º degrees, move away the conjunctiva, and place a silicone scleral buckle around the eye. The band itself is 41 mm, while the sleeve that holds the band is 72 mm. I anchor the band with 5-0 mersilene sutures in all four quadrants on the sclera at the equator, then tighten it to the proper height.

    Next, I make three incisions for the sclerotomy and proceed with the 25-gauge pars plana vitrectomy. Once the vitrectomy is complete and the vitreous is trimmed to a peripheral vitreous skirt, I check to ensure a posterior vitreous detachment is induced and the posterior hyaloid detaches.

    A drainage retinotomy follows, using an extrusion device and perform an air/fluid exchange, draining the fluid under the retina through the drainage retinotomy. Once the retina is flattened, I switch to endolaser and begin treatment, lasering any tears present.

    Good patient response

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