![]() A p-valueĠ.05 was considered to be statistically significant. A repeated-measures mixed model regression analysis was performed for multivariate analysis comparing SB sutures versus scleral tunnels controlling for surgeon, type of surgery (PPV with SB versus primary SB), buckle type, postoperative epiretinal membrane, and cataract status was performed. Group comparisons of the categorical data were performed using the Fisher's exact test. For within-group comparisons between baseline and final metrics, a paired t-test was used, and for comparisons between groups, the Wilcoxon rank-sum test was performed. Sub-analyses included outcomes of SB band type and eyes with only primary SB surgery without pars plana vitrectomy (PPV).įor statistical analysis, we used JMP software version 15.0 (SAS Institute, Cary, NC). Stable, localized subretinal fluid following primary SB was not considered a failure. Single surgery anatomic success was defined as posterior retinal attachment with no tamponade present, and no presence of subretinal fluid which could spread at three months postoperatively. ![]() The primary outcomes considered were single surgery anatomic success, postoperative visual acuity, and the development of postoperative strabismus that was noted at the final postoperative visit, which must have taken place more than three months following the surgery. Eyes that underwent scleral buckling procedures after the initial procedures, namely reoperations for recurrent retinal detachment, were excluded as well.ĭetailed demographic, preoperative, intraoperative, and postoperative follow-up variables were collected from each site using the secure online REDCap database. Additionally, eyes that underwent vitrectomy without SB, non-encircling SB surgery, pneumatic retinopexy, or laser barricade were excluded. Eyes with fewer than three months postoperative follow-up were excluded, as were eyes where the scleral suture or scleral tunnel metric was not recorded. Complex retinal detachments including retinal detachments that had previously undergone repair, tractional retinal detachments, and retinal detachments due to inflammation or endophthalmitis were excluded. We examined the outcomes of patients who received SBs (either primary scleral buckling or in combination with vitrectomy), and compared visual and anatomic outcomes, as well as the rates of postoperative strabismus, as defined as ocular misalignment. This report is a subgroup analysis of the PRO study. ![]() ![]() Institutional review board approval was obtained at each participating institution, and the study complied with the Health Insurance Portability and Accountability Act of 1996 and adhered to the tenets of the Declaration of Helsinki. Eye & Ear in Boston, and Mid Atlantic Retina/Wills Eye Hospital in Philadelphia. Louis, Associated Retinal Consultants/William Beaumont Hospital in Detroit, Mass. The Primary Retinal Detachment Outcome (PRO) study is a multicenter, interventional, retrospective cohort study of patients who underwent repair of noncomplex primary RRD from Januthrough Decemfrom VitreoRetinal Surgery in Minneapolis, The Retina Center in Minneapolis, The Retina Institute in St. The purpose of this paper is to present the anatomic outcomes following scleral buckling surgery comparing scleral tunnels to scleral fixated sutures, but additionally, to assess the development of postoperative strabismus between these two modalities. Similar to the lack of reports examining anatomic outcomes following the use of scleral tunnels or scleral sutures, there have been no reports assessing the development of strabismus comparing these two techniques for buckle fixation. The management of postoperative strabismus usually begins with prism therapy which may resolve the strabismus in the majority of patients, while other patients may require strabismus surgery or buckle removal. ĭiplopia from strabismus following SB surgery is often temporary, but chronic or permanent strabismus may also occur and is a well-known complication, with a reported incidence between 5% and 25%. The selection largely depends on surgeon's preference, and little data is available regarding comparative efficacy and outcomes. Currently, the most commonly performed is the use of scleral suturing to secure the SB directly on the surface of the sclera, but the use of scleral tunnels to affix the encircling buckle to the sclera is a popular technique as well. An initial report had a success rate of 65%, but over the years, scleral buckling has evolved and lamellar dissection is rarely performed. ![]() Schepens' initial technique describes a lamellar dissection of the sclera and placement of an element with external diathermy for retinopexy. The use of scleral buckles (SBs) to repair rhegmatogenous retinal detachments (RRDs) was pioneered by Custodis in 1949, with the first reported scleral buckling procedure performed in the United States in 1951 by Schepens. ![]()
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