Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments

Sena, Dayse F; Kilian, Raphael; Liu, Su-Hsun; Rizzo, Stanislao; Virgili, Gianni

doi:10.1002/14651858.cd008350.pub3

Cited by 12 publications

(12 citation statements)

References 39 publications

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“…Thus, the authors of a Cochrane review (Znaor L. et al, 2019) [15] based on an analysis of 10 studies in European countries, India, Iran, Japan and Mexico, which included 1307 patients, concluded that PPV compared to SB less often leads to repeated RD, with the exception of iatrogenic and cataract progression cases, but has the same result in terms of visual recovery. The authors of another Cochrane review (Sena D.F. et al, 2021) [16] based on the analysis of the results of studies conducted in Ireland, the USA and Italy, which included 274 participants (276 eyes), concluded that SB can be more or less equally effective compared to pneumatic retinopexy (PR) in terms of reliability of chorioretinal adhesion and reduction of the risk of re-detachment.…”

Section: Resultsmentioning

confidence: 99%

“…The authors of another Cochrane review (Sena D.F. et al, 2021) [16] based on the analysis of the results of studies conducted in Ireland, the USA and Italy, which included 274 participants (276 eyes), concluded that SB can be more or less equally effective compared to pneumatic retinopexy (PR) in terms of reliability of chorioretinal adhesion and reduction of the risk of re-detachment. However, the use of SB resulted in more myopic progression, which was interpreted as a sign of cataract development.…”

Section: Resultsmentioning

confidence: 99%

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Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Saoud

Serhiienko

2022

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Introduction. Retinal detachment (RD) is a common pathological condition that without timely surgical treatment leads to vision loss. The patients with significant RD undergo one of three retreatment procedures: Pneumatic Retinopexy, Scleral Buckling, and/or Pars Plana Vitrectomy. Techniques and tools for these procedures have been developed, but the methods themselves still have a significant number of complications. A possible alternative to their further improvement may be a fundamentally new method of treatment, coagulation of the retina with high-frequency electric current (HFEC), for which significant improvement of the tool is still possible. The purpose of the study was to determine a safer method of RD treating and to improve medical tools for restoring anatomical integrity and repositioning a detached retina under two conditions: firstly, obtaining a reliable chorioretinal adhesion, and secondly, minimizing the number of incidental effects of surgical intervention. Materials and methods. The bibliosemantic method, the system analysis method, an experiment on laboratory animals (rabbits) with RD simulation and its coagulation by HFEC, tissue biopsy of operated animals after their euthanasia on the 7th day after surgery, and the production of histological micro-preparations were used. Results. To fulfill the conditions for improving the method, a chorioretinal high-frequency electrocoagulation operation with suprachoroidal access, a modified EK-300M1 generator (Kyiv, Ukraine) with an electrode with a gold hemispherical tip of 25 gauge and electrical generation parameters of 66 kHz, 10‒16 V, 0.1 A was proposed, which causes chorioretinal adhesion in the place where the electrode is used. The method of calculating the parameters of heat transfer from the electrocoagulation tool to the tissues and fluids of the eye was selected: it was proposed to use the Fourier-Kirchhoff and Newton-Richmann equations. Destructive phenomena in the retina from the thermal effect of tissue coagulation in the form of the destruction of rods, cones, the development of cysts, the loss of bipolar, amacrine, horizontal and ganglion cells were noted. Atrophic changes in the retina were minimal at a voltage of 10‒12 V. Conclusions. The problem of improving the methods of restoring the anatomical position of the retinal layers has been relevant for many decades, but it does not lead to a significant reduction in the number of complications. The proposed method and tool for its application causes the creation of a reliable chorioretinal adhesion in a short period of time after surgical intervention with minimal thermal tissue damage. The use of the method of chorioretinal high-frequency electrocoagulation with suprachoroidal access is recommended in conditions of urgent restoration of vision, but not recommended for the prevention of retinal detachment in retinopathies. Keywords: retinal detachment, chorioretinal adhesion, high-frequency electrocoagulation, suprachoroidal access.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Saoud

Serhiienko

2022

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“…Кожний з цих методів має свої переваги та недоліки, межі відновлення гостроти та полів зору, ризики повторних відшарувань та ускладнень [6; 7]. Тривала дискусія про найкращий метод офтальмохірургічного лікування включає обговорення трьох основних методів фіксації шарів сітківки після її відшарування -кріо-, лазеро-та електропексію [7][8][9][10][11][12][13]. Нами було проведено власне експериментальне дослідження відновлення анатомічної цілісності сітківки за допомогою високочастотної електрокоагуляції (сила струму 0,1 А, напруга 10-16 В, частота 66 кГц) супрахоріоїдальним доступом, інструментом оригінальної конструкції з діаметром кінцевої сфери 25 G [14; 15].…”

Section: вступunclassified

Morphometric study of the chorioretinal complex of laboratory animals in an experiment with electrocoagulation of the retina via transvitreal access

Saoud,

Turchyn,

Serhiienko

et al. 2023

ECM

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Retinal detachment occurs primarily as a result of diabetes, high myopia, and eye injuries. Restoration of the anatomical integrity of the detached retina is performed urgently using methods that allow fixing the displaced layers of the retina in their usual place – cryo-, laser-, and electropexy methods. There is no consensus on which of these methods is better. Our study is devoted to electropexy, namely high-frequency electrocoagulation, and describes an experiment on modeling the restoration of the anatomical integrity of a detached retina on lab rabbits of the chinchilla breed using an instrument of original design – a monopolar coagulator with a 25 G tip. 33 rabbits (66 eyes) were divided into four groups: the control group (6 animals) and 3 groups (9 animals each), which were operated using an electric current with a frequency of 66 kHz, a current of 0.1 A, and voltages of 10–12 V (I group), 12–14 V (II group) and 14–16 V (III group) and transvitreal access. All rabbits were subjected to euthanasia: rabbits of the control group (intact) – at the beginning of the experiment, operated rabbits (I–III groups) – 30 days after the operation. Eyes were enucleated, tissues of chorioretinal structures were stained with hematoxylin-eosin and studied under light microscopy with measurement of retinal thickness using the software "ImageFocusAlpha" (Netherlands) version 1.3.7. The results of morphological and morphometric studies were compared with the results of our other experiment conducted earlier with similar conditions of impact on chorioretinal structures, but with suprachoroidal access. The research and comparison showed that both with suprachoroidal and transvitreal accesses, with a current frequency of 66 kHz and a current strength of 0.1 A, the optimal exposure voltage is 10–12 V, and the best approach is the suprachoroidal access. Keywords: vitreoretinal surgery, retinal detachment, retinal thickness.

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“… 101 A recent Cochrane review concluded that PR had a lower reattachment rate and a higher recurrence rate but a lower burden of post-operative complications compared to SB. 102 Data from a commercial insurance database from the USA showed that almost 30% of cases managed by primary PR compared to 20% of cases managed by either SB or PPV required a reoperation within 90 days of the primary repair. 103 More recently, the Primary Retinal Detachment Outcomes 104 Study reported that in phakic patients there was, not only a higher success rate with a single procedure with SB compared to patients undergoing PPV (91.7% vs 83.1%) but also a better visual acuity in patients undergoing SB.…”

Section: Outcomes Of Retinal Re-attachment Proceduresmentioning

confidence: 99%

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Pimentel¹,

Shih²,

Wu³

2022

OPTH

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Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.

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Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments

Abstract: Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments.

Cited by 12 publications

References 39 publications

Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Morphometric study of the chorioretinal complex of laboratory animals in an experiment with electrocoagulation of the retina via transvitreal access

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

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