Wide-Angle Viewing System versus Conventional Indirect Ophthalmoscopy for Scleral Buckling

Abstract

Wide-angle viewing systems (WAVSs) were originally established for pars plana vitrectomy. However, their application to scleral buckling surgery was recently reported. In this study, we compared the outcomes of scleral buckling using a noncontact WAVS with that of scleral buckling using conventional indirect ophthalmoscopy for rhegmatogenous retinal detachment. The clinical records of 39 eyes (39 patients) with rhegmatogenous retinal detachment primarily treated between November 2012 and June 2014 at the Vitreo-Retina Surgical Division Clinic at the Department of Ophthalmology, Keio University Hospital were retrospectively reviewed. Scleral bucking was performed using WAVS with surgical placement of an endoilluminator in 16 eyes and indirect ophthalmoscopy in 23 eyes. The patients in these groups were consecutive over different intervals. The preoperative demographics, success rate of retinal reattachment, intraoperative findings, and postoperative complications were evaluated. There were no significant differences in pre- or postoperative conditions between groups, and similar surgical outcomes were achieved with the WAVS and conventional procedures. However, compared with the conventional procedure, the WAVS procedure resulted in fewer intraoperative corneal epithelial disorders (p = 0.049) and decreased the surgical duration of segmental buckling (p = 0.02); therefore, it may be suggested as an effective alternative procedure.

Role of Caveolin-1 for Blocking the Epithelial-Mesenchymal Transition in Proliferative Vitreoretinopathy

“…1,2 Although the robust improvement in surgical instruments has enabled a very high rate of structural attachment in RD, [3][4][5] RDs with severe complications, including giant retinal tears, multiple retinal tears, and/or vitreous hemorrhage, often develop into PVR. 6 Proliferative vitreoretinopathy is characterized by fibrotic changes in the detached retina combined with fibrovascular membranes (FVMs) and subretinal bands (SRBs).…”

Acute bacterial endophthalmitis after scleral buckling surgery with chandelier endoillumination

“…There are several reasons why the WAVS is becoming more commonly used for scleral buckling surgery to treat RRDs. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 In general, the success rate with WAVS is almost equal to that with indirect ophthalmoscopy-guided buckling surgery. In some reports, the surgical duration was significantly shorter with WAVS than with conventional scleral buckling surgery.…”

“… 3 , 4 , 5 Many recent studies have reported that the non-contact WAVS combined with endoillumination is an effective way to view the surgical field during scleral buckling surgery for RRDs. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Although its usefulness compared to an indirect ophthalmoscopy-guided surgery has been suggested, there has been only one report on the complications related to its use. 15 More specifically, the development of infectious endophthalmitis has not been reported in spite of the use of a chandelier endoilluminator that is inserted through the conjunctiva which is most septic site for infectious intraocular organisms.…”

Roles of Hypoxia Response in Retinal Development and Pathophysiology

“…The author is supported by the Manpei Suzuki Diabetes Foundation, a JSPS Postdoctoral Fellowship, MEXT KAKENHI Grants, the Uehara Memorial Foundation, the Japanese Retinitis Pigmentosa Society, the Takeda Science Foundation, and the Keio University Medical Science Fund. 7 Ectopic HIF activation in RPE cells led to both neovascular and atrophic retinal degeneration mimicking age-related macular degeneration (based on the results of Kurihara et al 39 ) (A) Schematic depicting how dysregulated HIF degradation in the compromised VHL E3 ubiquitin ligase complex may result in increased transcription of HIF target genes in RPE cells. Ectopically stabilized HIFαs can alter the expression of angiogenesis genes and energy homeostasis gene networks.…”

“…In the past decade, the roles of the hypoxia response in the development, physiology, and pathophysiology of the retina have been investigated and revealed by utilizing cell-type-specific conditional knockout mice. Although clinical studies have been performed and new surgical instruments and procedures have been developed, [4][5][6][7] several problems remain unresolved. For example, photoreceptors basically cannot be regenerated once they are lost in the degenerated retina in conditions such as retinal detachment, retinopathies, and retinitis pigmentosa.…”