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    Exploring a new method for scleral buckling

    A temporary device overcomes many of the drawbacks of scleral buckling.

     

    Take home

    A retinal surgeon describes a new scleral buckling device which requires less surgical dissection, has a one or two-stitch fixation, is applicable to treat pathology over 4 clock hours in any quadrant, and which can be removed in the office 3 to 4 weeks after insertion.

     

    San Diego—Scleral buckling “is not dead,” nor should it be, said Paul E. Tornambe, MD. Scleral buckling (SB) indents the retina underlying a break and is believed to alter intraocular fluid currents that in turn allow the retinal pigment epithelium to remove existing subretinal fluid and reduce a retinal detachment to a mere retinal tear. The first reported procedure was in 1937, and incremental improvements in technique have rendered it a proven method for reattaching the retina, Dr. Tornambe said.

    Success rates are high; complications such as endophthalmitis are low.

    More in this issue: U.S. surgeons anticipate new IOLs

    “Once the subretinal fluid is removed, you should treat the retinal tear like you would any other tear not associated with subretinal fluid,” he said. Scleral buckling has lost favor by many retinal surgeons for a few reasons, he said; when compared with pars plana vitrectomy, the traditional SB procedure necessitates a more extensive preop evaluation. Conventional buckling can result in induced refractive error and sometimes muscle imbalance, discomfort, infection, and extrusion of the buckling material. Scleral buckling surgery is more time-consuming; it requires a detailed preoperative evaluation of the retina, an operating room, and may require general anesthesia. Although there have been many technological advances in the instruments and techniques we use today to treat a retinal detachment, the scleral buckling materials and procedure has not changed over the past 50 years.

    “We have developed a new scleral buckling device which requires less surgical dissection, has a one or two-stitch fixation, is applicable to treat pathology over 4 clock hours in any quadrant, and which can be removed in the office 3 to 4 weeks after insertion,” he said, noting it is based on the Lincoff balloon concept that a permanent buckle in many cases is not needed. That balloon device failed to achieve commercial success, but “the concept was brilliant,” Dr. Tornambe has said.

    Using a temporary buckle

    The removable circumferential SB is patent-pending. The first prototype, “a compressible football simulating a balloon, was first described by us about a year ago,” Dr. Tornambe said. “The football worked in a few cases but tended to migrate and that design has been put on the back burner. However, the concept that a permanent scleral indentation is not needed excited us and kept us on the path to search for a better design for a temporary buckle.”

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