![]() Localization : The retinal breaks and areas of lattice degeneration in the detached retina are localized with the aid of indirect ophthalmoscope. Scleral dehiscence appears as radial areas of scleral thinning through with the underlying choroidal pigmentation shines through. ![]() The intermuscular fascia is wiped posteriorly with a cotton tip applicator and the quadrants are inspected, looking for areas of scleral dehiscence, anomalous insertion of vortex veins and staphyloma. It is preferable to hook the superior rectus from the medial to the lateral side to prevent inadvertent tagging of superior oblique muscle. Sweeping the muscle hook close to the insertion of the muscle will avoid inadvertent hooking of vortex veins. Muscle tagging: The four recti muscles are tagged with 2’0 silk sutures, aided by muscle hooks with eyelets. 1B- The tenon conjunctival adhesions are lysed. The tenon conjunctival adhesions are lysed in the four quadrants by introducing the tip of the blunt curved scissors, hugging the sclera, and opening the blades.įigure 1A- A 360 0 limbal peritomy is performed. The limited peritomy however extends 1 clock hour beyond the quadrant on either side to facilitate muscle tagging. If a segmental buckle is planned without an encircling band, peritomy is limited to the quadrant of the episcleral explant. Peritomy: A 360 0 limbal peritomy is performed if an encircling band is to be placed. Pre-operative antibiotic prophylaxis is usually not necessary instillation of Povidone Iodine 5% eye drops in the conjunctival cul-de-sac prior to surgery is however, required.Īn adjustable lid speculum is used to keep the lids open after cleaning the eye and periorbital areas with Povidone Iodine 10% solution and draping the eye. A mixture of lignocaine 2% and bupivacaine 0.5% with hyaluronidase 7.5units/ml and 1:10000 adrenaline is used for anesthesia. Scleral buckling can be performed under peribulbar, parabulbar or retrobulbar anesthesia general anesthesia being preferred for children and apprehensive adults. A silicone tire with an encircling band is preferred in eyes with peripheral retinal degeneration and /or multiple breaks or vitreous traction in multiple quadrants. Scleral buckling may be only segmental wherein a segmental buckling element (tire) is placed episclerally over the lesion an encircling element is not placed. Post-glaucoma surgery wherein peritomy can compromise the bleb or in the presence of a glaucoma implant which can interfere with the buckle placement advanced glaucomatous optic atrophy wherein the possible temporary elevation of intraocular pressure due to scleral buckle can compromise the remnant field medically uncontrolled glaucoma which may necessitate anti-glaucoma surgery.Patients with a potential vaso-occlusive disease such as sickle cell disease as it may increase the risk of anterior segment ischemia. ![]() Combined traction rhegmatogenous retinal detachments.Prior squint surgery (recession of muscle) in the quadrant requiring scleral buckling.Rhegmatogenous retinal detachment associated with peripheral retinal break and macular hole.Retinal detachment in pseudophakic eyes – Comparative studies indicate better surgical results with vitrectomy in pseudophakic rhegmatogenous retinal detachment.Opaque media – wherein retinal breaks may be missed.Breaks difficult to access by scleral depression, even with the eye in the primary position may be difficult to treat by scleral buckling) Posterior retinal breaks (can be judged in the clinic by scleral depression.Coloboma choroid associated retinal detachment 6.Retinal detachment associated with retinal dialysis 5.Young patients with adherent posterior hyaloid.Uncomplicated rhegmatogenous retinal detachment up to proliferative vitreoretinopathy (PVR) grade C1. Relief of vitreoretinal traction by indenting the sclera towards the retinal break and closure of the break.Retinopexy – creating a sterile inflammatory reaction that would result subsequently in chorioretinal adhesion that seals the retinal break.General principles of retinal detachment surgery- Search for the breaks, find all the breaks, seal all the breaks, and relieve vitro retinal traction. The aim of scleral buckling is to close all retinal breaks to achieve permanent reattachment of the retina. Scleral buckle surgery evolved out of the works of Jules Gonin, who identified retinal breaks as the cause of retinal detachment, Custodis, Lincoff and Schepens who devised ways of using an epi / intrascleral implant to “ buckle ” the sclera inward to create the indent. ![]() Scleral buckling indents the sclera and the overlying choroid retinal pigment epithelium complex towards the retinal break in the detached retina, resulting in retinal reattachment. Scleral buckle surgery is indicated for uncomplicated rhegmatogenous retinal detachments.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |