Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure

Abstract

Purpose To assess the outcome of sutureless encirlcing number 41 band and transscleral laser retinopexy in uncomplicated rhegmatogenous retinal detachment (RRD), using a wide-angle viewing system (WAVS) and chandelier endoillumination. Methods Prospective intervention study included 30 eyes of 30 patients presenting with RRD of recent onset indicated for SB. All cases were treated by sutureless encircling number 41 band and transscleral laser retinopexy. Visualization was provided by the Resight WAVS and a single 27-gauge chandelier endoillumination. Anatomical and visual outcomes were evaluated. Results The mean age of our group was 49.8 ± 12.3 years, and the mean duration of RD was 7 (0–50) days. Twenty-four eyes (80.0%) were phakic while the remaining 6 eyes (20%) were either pseudophakic or aphakic. The primary retinal reattachment rate was 83.3% (25 out of 30 eyes). LogMAR visual acuity improved from 1.3 (0.30–2.0) preoperatively to 1.0 (0.40–1.60) at first month (p = 0.002) and to 0.70 (0.20–1.92) at third month (p < 0.001). Conclusion Sutureless encircling number 41 band with chandelier-assisted transscleral laser retinopexy is a safe and effective technique for managing uncomplicated RRD. It provides a high primary success rate while eliminating the complications of cryotherapy, sutures, and broad buckles.

Chandelier-Assisted Versus Standard Scleral Buckling for Primary Rhegmatogenous Retinal Detachment

“…Some studies excluded the gauge size as a risk factor for the vitreous prolapse, 22 while others believed it might be a contributing factor. 13,26,29 In our study, we had 52.1% incidence of vitreous entrapment (P2) on UBM, where other studies reported lower rates. 28 Vitreous incarceration plugging the sclerotomy can lead to many complications.…”

“…Some studies excluded the gauge size as a risk factor for the vitreous prolapse, 22 while others believed it might be a contributing factor. 13,26,29…”

Outcomes of Chandelier-Assisted Scleral Buckling in Rhegmatogenous Retinal Detachments: Systematic Review and Meta-analysis

“…2,8,18,24 Six studies reported this complication, with incidences ranging from 5% to 48%. 2,8,10,18,24,30 Sutures at the sclerotomy site were also needed in some of the reported cases. 10,30 Authors have proposed methods to reduce the risk for vitreous prolapse, including using valved cannulas, paracentesis, or subretinal fluid drainage to lower IOP before trocar removal; inserting the trocar obliquely; or plugging the cannula during episcleral procedures as well during removal of the trocar.…”

“…It has been suggested that fixing the silicone band to the sclera before trocar and cannula insertion allows better control of the endoilluminator and minimizes the risk for lens touch and creation of new retinal breaks. 18 In pseudophakic patients, PPV is performed more often than standard scleral buckling. 8 Factors such as poor pupil dilation, cortical remnants, capsule opacification, and intraocular lens optical aberrations in pseudophakic patients make it difficult to obtain a satisfactory view with the indirect ophthalmoscope.…”

“…Since then, several studies have examined the efficacy of chandelier-assisted scleral buckling surgery, with some studies also comparing it to standard scleral buckling. 2,5,6,8,10–35 The advent of chandelier scleral buckling has helped improve the identification of retinal breaks that may have been previously missed in the preoperative examination when performing standard scleral buckling. 6 Chandelier scleral buckling also has the added benefit of potentially improving visualization in pseudophakic eyes.…”