Modified Hamilton’s Controlled Encircling Procedure for Retinal Detachment

Abstract

To describe a novel, simple, and reproducible encircling scleral buckle technique based on Hamilton's controlled encircling procedure in order to standardize buckle height achievement in cases of retinal detachment. Methods: We describe a case series in which a novel modification of Hamilton's surgical technique was used, consisting of a typical encircling buckling procedure anchored in the center of each quadrant, with the ends of the band passed through a Watzke sleeve. Reference marks were placed to allow measurable shortening of the band when its ends were pulled to create an encircling indent. Postoperative ultrawide field retinal images were analyzed. Results: Our simple technique yielded predictable and reproducible postoperative scleral buckle heights. Shortening of the silicon band by 3, 4, 5, and 6.25 mm produced shallow indents, while additional shortening was considered excessive. Conclusion: Published studies about scleral buckle as a primary procedure or a combined technique with vitrectomy lack a uniform surgical technique. Our modification of Hamilton's technique uses objective measurements to generate a consistent and predictable postoperative buckle height.