Segmental Scleral Buckle: Rapid Postoperative Recovery - PDF Document

Presentation Transcript

  1. Segmental Scleral Buckle: Rapid Postoperative Recovery Vincent Reppucci, MD Director Retina Service St. Luke’s-Roosevelt Hospital Center New York City, USA 5th THESSALONIKI INTERNATIONAL VITREO-RETINAL SUMMER SCHOOL 23-27 June, 2014 Electra Palace Hotel, Thessaloniki, Greece

  2. Localized Scleral Buckle • Scleral buckling is a very effective, efficient, and too often underconsidered tool in the armamentarium of vitreoretinal surgeons. • Localized Scleral Buckle can allow for rapid retinal detachment recovery often without activity limitations or extended postoperative positioning. • I will present several cases where a localized scleral buckle was an ideal option for repair of primary and recurrent retinal detachment, highlighting the rapid recovery. • My intent is to increase awareness of what

  3. Post-op Recovery to unrestricted physical and visual activity • Pneumatic or Vitrectomy – 2 - 4 weeks or longer • May require face down or lateral positioning • Travel restrictions • Gas bubble will interfere with binocular reading vision • Localized Scleral Buckle – 1-2 days • Up to 7 days for delayed SRF resorption

  4. Scleral Buckle Procedure • Localized sponge • No drainage – If need to drain 25g needle into open syringe direct visualization • No cryo • Indirect laser intraop or postop

  5. Localized Scleral Buckle Procedure Exposur e Incisio n Videos courtesy of Vincenzo Ferrara, MD Localizatio n

  6. Localized Scleral Buckle Procedure Mattress Suture Mattress Suture Videos courtesy of Vincenzo Ferrara, MD

  7. Scleral Buckle Benefit • Rapid postop recovery – Minimal positioning – Rapid resumption of reading and physical activity – No air travel restrictions • Effective “tamponade agent” – Extraocular and optimal for inferior pathology – Can be supplemented – Reversible

  8. Scleral Buckle Negatives • Suture related discomfort – Try to place 6-8mm from limbus • Refractive error, usually mild astigmatism • Transient diplopia • Persistence of floaters

  9. Buckle Considerations • Employment requirements • Ocular status – phakic • Age and compliance • Acute travel requirements • Tear and pathology location – 11 to 1 o’clock try to avoid – Inferior bias

  10. 57 y.o. Attorney • OS Macula on • Nasal tear • 3x5 silicone sponge @9:00 beneath medial rectus • Nondrainage • “Workaholic”

  11. 57 y.o. Attorney • Next morning • Patient removed patch – Resumed reading work • In afternoon called secretary to find him in office • Flat

  12. 62 y.o. Flight Attendant • Mac off OS • HST @1:30 • Break @11:00 attached retina • NY to London flights • Flies in 4 days • 3x5 radial sponge @ 1:30 nondrainage

  13. 62 y.o. Flight Attendant • Laser SN tear • 3x5 radial sponge @ 1:30 nondrainage • Flat next day • Able to resume flight schedule • 20/40 vision

  14. 73 y.o. male • Substance abuse • Mac off • HST @ 7:00

  15. 73 y.o. male • 3x5 radial sponge • Nondrainage • Flat next morining • Pain postop went out and snorted heroin

  16. 14 y.o swimmer • Macula off • Dialysis 4:00-5:00 • High School Swim Team

  17. 14 y.o swimmer • Circumferential 3x5 sponge • Nondrainage • Resume school 2 days • Resume swimming 1 week • 20/60

  18. 16 y.o male • Inferior RD chronic • Atrophic hole @ 4:30 • Mac off

  19. 16 y.o male • 3x5 radial @ 4:45 • Nondrainage • 20/60 • Resume school 3 days

  20. 49 y.o monocular pseudophake • OD CF Multiple vitrectomies • Lives in Florida • break@ 4:00 equator

  21. 49 y.o monocular pseudophake • 3x5 radial nondrainage • Flat 3 days • Return to Florida 5 days

  22. 13 y.o. recurrent RD • 16 y.o probable wegener’s • s/p vx c3f8 sb for mac on IT RD • Recurrent RD large new break @ 5:00- 6:00

  23. 13 y.o. recurrent RD • Grooved sponge inferiorly • Gas bubble not removed • Retains phakic 20/20 vision 13 years later

  24. 49 y.o inferior RD beneath Silicone Oil • s/p pneumatic • Vx c3f8 • Vx sb silicone oil • Break @5:00 • Administrator Law Firm

  25. 49 y.o inferior RD • 3x5 radial sponge • nondrainage • Flat next morning • Resume work 3 days • Remove si in future without tamponade

  26. Bias towards Vitrectomy with Internal Tamponade • Technological advancement and improved instrumentation • Improved outcomes • Reduced operating time • Improved intraoperative visualization • Equal or better success rate

  27. Bias against Scleral Buckle • Teaching Program – Stress vitrectomy – Complicated surgery • Sutureless surgery anterior and posterior • Encirclement vs Segmenyal localized sponge • Preoperative examination • Intraoperative localization • Intraoperative drainage

  28. Conclusion • Segmental scleral buckle is an effective method for primary and recurrent RD repair • Allows for most rapid postoperative recovery in selected cases • Requires a certain skill set different from vitrectomy which may be very useful to the vitreoretinal surgeon and patient.