IntroducEon Methods Results A Novel Surgical Technique For

A Novel Surgical Technique For Encircling Scleral Buckle Surgery For Primary Re)nal Detachment Dimitra Skondra MD, Eugene Shildkrot MD, Aristomenis Thanos MD, Demetrios Vavvas MD, PhD MassachuseKs Eye & Ear Infirmary, Harvard Medical School, Boston, MassachuseKs Introduc)on During encircling scleral buckle placement, the ends of the element/band are 8ghtened in order to achieve a shortened radius of the eye at the place of the buckle. The determining factor for how much the band should be 8ghtened is usually es8mated subjec8vely by the height of the buckle on indirect ophthalmoscopy and can be difficult to be taught early on to trainees. Here we describe a novel encircling scleral buckle technique that simplifies and standardizes the achievement of reproducible buckle height of 1 mm that is objec8ve and easy to be taught. Figure 3 Figure 2 Methods According to geometry rules, the circumference of the globe is 2πR where R is the radius of the globe and π the standard value of 3.14. If buckle height is 1mm, which we consider to be an ideal buckle height, the new circumference of the globe should be 2π(R-­‐1mm). The difference between the two circumferences is always 2π=6.28mm independently of the ini8al radius of the globe (Figure 1). Figure 1 Wide angle Optos fundus photos of a pa8ent with primary RD at postopera8ve month 1 demonstra8ng resolu8on of subre8nal fluid with good buckle height and contour To make easy of the calcula8ons and because we usually measure cord length we simply shorten the encircling buckle element by about 5mm a\er cu]ng the two ends flush. Subsequently we directly appose and 8e the ends with three interrupted 5.0 nylon sutures (Figure 2). We secure the element in place with a double pass maKress suture. Results Six pa8ents, 4 males and 2 females with primary re8nal detachment underwent encircling buckle placement using this novel technique. The average age was 29 years old and mean follow up 8me was 17 months. All six pa8ents had good buckle height postopera8vely and in five out of six pa8ents the re8nal detachment resolved and re8na remained aKached during the follow up period. (Figure 3,4). Figure 4 Montage wide angle Optos fundus photos of another pa8ent with primary RD at postopera8ve day 1 demonstra8ng resolu8on of subre8nal fluid with good buckle height and contour Conclusions This novel encircling scleral buckling technique successfully achieves an ideal postopera8ve scleral buckle height in a reproducible and standardized fashion using objec8ve measurements. This is easier to be taught to trainees. Methods •  Globe circumference is 2πR where R is the radius of the globe and π the standard value of 3.14. If buckle height is 1mm, which we consider to be an good buckle height, the new circumference of the globe should be 2π
(R-­‐1mm). The difference between 2πR and 2π(R-­‐1) is always 2π=6.28mm, independent of the ini8al radius of the globe. •  We first place the buckle around the globe and cut the ends flush. To simplify calcula8ons, we shorten the encircling buckle element by about 5mm. We then directly appose and 8e the ends together with three interrupted 5.0 nylon sutures and secure the element in place with double pass maKress sutures. Results Results •  Six pa8ents, 4 males and 2 females with primary re8nal detachment underwent encircling buckle placement using this novel technique. The average age was 29 years old and mean follow up 8me was 17 months. •  All six pa8ents had good buckle height postopera8vely and in five out of six pa8ents the re8nal detachment resolved and the re8na remained aKached during the follow up period. No scleral buckle related complica8ons were no8ced in any of the cases intraopera8vely or postopera8vely. Results Wide angle Optos fundus photos of a pa8ent with p r i m a r y R D a t p o s t o p e r a 8 v e m o n t h 1 demonstra8ng resolu8on of subre8nal fluid with good buckle height and contour Montage wide angle Optos fundus photos of a n o t h e r p a 8 e n t w i t h p r i m a r y R D a t postopera8ve day 1 demonstra8ng resolu8on of subre8nal fluid with good buckle height and contour Conclusions •  This novel encircling scleral buckling technique successfully achieves an ideal postopera8ve scleral buckle height in a reproducible and standardized fashion using objec8ve measurements. This is easier to teach to trainees.