The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

/pdf/scleral-buckling-a-brief-historical-overview-and-current-48f5i07nvs.pdf

Management of Vitreo-Retinal Disease

Scleral buckling—a brief historical overview and current indications

For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks remain open at the end of surgery Various explanations have been put forward, but none more interesting than the effect of fluid currents associated with eye movements One such explanation involved the physics of the Bernoulli’s principle Daniel Bernoulli was an eighteenth century Swiss mathematician and he described an equation based on the conservation of energy The sum of pressure energy, potential energy and kinetic energy remains constant Bernoulli’s equation usually applies to closed system such as the flow of fluid through pipes When fluid flows through a constriction, the speed of fluid increases, the kinetic energy increases If there was no change in elevation (potential energy), then the increase in kinetic energy must be accompanied by a decrease in pressure energy In ophthalmic surgery, the Bernoulli’s effect is the basis for venturi pumps that drive vitrectomy and phacoemulsification machines This essay expounds on how Bernoulli’s effect might be relevant to scleral buckling for retinal detachment repair In the era when vitrectomy is increasing the primary surgical operation for retinal detachment, the pervasive advice is to emphasise the importance of patient adopting head posture and remaining still postoperatively The exception is non-drainage scleral buckling surgery Early postoperative mobilisation may be vital to achieve reattachment

/pdf/intraocular-currents-bernoulli-s-principle-and-non-drainage-2cncjqkhny.pdf

Management of Vitreo-Retinal Disease

Citations

Scleral buckling—a brief historical overview and current indications

Intraocular currents, Bernoulli’s principle and non-drainage scleral buckling for rhegmatogenous retinal detachment

Benetzungsstrungen nach Netzhautchirurgie und okulrer Tumortherapie

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