Eye Unit, Humanitas-Gradenigo Hospital, Turin, Italy.
Eur J Ophthalmol. 2021 Mar;31(2):804-806. doi: 10.1177/1120672120945091. Epub 2020 Jul 22.
Scleral buckling (SB) has been the first technique to repair a retinal detachment (RD) and it is still largely in use. Pars plana vitrectomy (PPV) is currently the most common technique, being more versatile and easier to approach. Here we report on a new SB variant, modified by using some of the latest technological advances borrowed from PPV.
We retrospectively reviewed all our SB cases from November 2017 to November 2018, all of them performed with a chandelier, mounted on valved trocar, to provide 3D wide-angle viewing. 107 eyes of 107 patients (mean age of 59 ± 8 years, 61 [57%] males) underwent primary uncomplicated RD surgery using this modified SB technique and were enrolled for this study.
In this article, the technique is thoroughly described with an online video presentation. Briefly, thanks to valved trocar insertion, it combines the latest breakthroughs in the field of PPV viewing systems with traditional SB surgery. Our first-year data reveal a primary success rate of 94% (101 cases out of 107) at 3 months follow-up. A hidden retinal lesion, undetected at clinical pre-operative evaluation, was found intraoperatively in 12 (8.9%) cases.
The use of a digital three-dimensional (3D) visualization system, coupled with the positioning of a single 25 gauge valved trocar with chandelier, dramatically simplifies the traditional SB and flattens its learning curve, making this procedure more accessible to young surgeons. In addition, the better visualization capability yields to higher possibility to detect and treat all retinal lesions.
巩膜扣带术（SB）是修复视网膜脱离（RD）的第一种技术，目前仍在广泛应用。玻璃体切除术（PPV）是目前最常用的技术，它更具多功能性，更容易操作。在此，我们报告一种新的 SB 变体，它通过使用一些从 PPV 中借用的最新技术进行了改进。
我们回顾性地分析了 2017 年 11 月至 2018 年 11 月期间所有使用吊灯式器械，安装在带阀套管上的 SB 病例，以提供 3D 广角视野。107 例 107 只眼（平均年龄 59±8 岁，61 例男性，占 57%）接受了这种改良的 SB 技术治疗原发性单纯 RD，并纳入本研究。
本文详细描述了该技术，并附有在线视频演示。简而言之，由于阀套管的插入，它结合了 PPV 观察系统领域的最新突破与传统 SB 手术。我们的一年数据显示，在 3 个月的随访中，原发性成功率为 94%（107 例中有 101 例）。在 12 例（8.9%）病例中发现了术中未在临床术前评估中发现的隐匿性视网膜病变。
使用数字三维（3D）可视化系统，并结合单个 25G 带阀套管的吊灯定位，极大地简化了传统的 SB，并使该手术的学习曲线变平，使年轻外科医生更容易掌握。此外，更好的可视化能力提高了发现和治疗所有视网膜病变的可能性。
