Scleral Buckling Using a Non-contact Wide-Angle Viewing System with a 25-Gauge Chandelier Endoilluminator

Abstract

PurposeTo report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator.MethodsRetrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination.ResultsThe patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached.ConclusionsScleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.

Wide-angle 3D viewing system with valved trocar applied to chandelier-assisted scleral buckling

“…10 Moreover, the possibility to digitally filter the image can further enhance surgeon visualization capability. Many authors have already reported on WAVS-assisted SB, 6–9 but the main advantage when add a 3D system is the possibility to examine a wide filed of retina periphery at high magnification without loosing definition.…”

“…Many hybrid procedures have been proposed so far, in the attempt to simplify SB using some of the PPV tools, especially the chandelier. 5–9 Here we report of our own hybrid technique that combines the standard SB procedure with WAVS, 3D viewing and, for the first time, a valved trocar system.…”

Effectiveness of Scleral Buckling with a Wide-Field Surgical Microscope and Chandelier Illumination in Retinal Detachment Repair

“…It can help surgeons suffering from neck strain or back pain. Furthermore, the duration of surgery is significantly shorter in time with this technique compared to conventional scleral buckling [25, 26]. The second advantage is that the operation can be performed simultaneously while adjusting the focus and magnification of the surgical field with the surgical microscope.…”

Commentary: Revival of scleral buckling technique with Chandelier illumination

“…Many complex RRD can be tackled with better illumination as highlighted in a case report where CSB was possible in case of retained intraocular foreign body. [8] One case report showed CSB success in identification of undetected break preoperatively. [9] Comparison of features between SSB, CSB, and PPV is illustrated in Table 1.…”

“…Surgical time is also seen to be significantly reduced in CSB according to two studies which compared CSB and SSB outcomes. [810] CSB and SSB are cost-effective when compared with PPV. Surgeon's neck comfort is well taken care of in CSB.…”