This is my latest recording of surgery for a retinal detachment.
This is the second of (what I hope) to be a series of “videos” on the surgical aspects of retinal eye disease. This is a recording of two procedures often combined to repair, or fix, a retinal detachment.
Now, this video is quite graphic. Believe it or not, however, the patient is completely comfortable…as it does not hurt. I generally favor this procedure be done with a retrobulbar block (this is an injection behind they eye that “blocks” all pain conduction) in addition to very light sedation for this eye surgery.
On occasion general anesthesia is preferred.
The scleral buckle is passed around the outside of the eye and underneath each of the 4 four rectus muscles. I sew the buckle to the eye using some thin suture material. In the video, the suture is white in color.
There are various techniques to pass the buckle around the eye and innumerable varieties of buckles from which to choose. I have used the same, small thin buckle almost exclusively for the last 10 years. I do not think the size or thickness of the buckle, nor its material, is important.
I prefer to always go completely around the eye. Some choose to place the buckles in different orientations and configurations. Again, I don’t think this is important.
By repeating the same techniques over and over, my surgical team can easily anticipate my each and every move. They can be sure to accurately predict the correct instruments and materials I’ll need for each part of the case.
In this way, we have developed a very efficient surgical model for our patients. From the technical aspect, we are quite competent having done this time and time again. From the patients perspective, there is less surgical trauma and reduced time under anesthesia.
I believe that the more efficient a team, the less likely complications may occur due to reduced operating time and increased experience of the team.
After the scleral buckle is placed, I then go inside the eye and repair the retinal detachment from the inside by performing a vitrectomy. This “3 port” system is not unlike arthroscopic surgery or laparoscopic surgery…all “closed” systems.
The goal of the vitrectomy is to remove the stressers on the retina by removing the vitreous. I can also remove the fluid from within the vitreous cavity (where fluid is normally located) and underneath the retina (abnormally located fluid.)
Intraocular gas used to temporally keep the retina reattached while appropriate scarring takes place. The scarring is induced usually by use of the laser. The goal of the laser is to “spot weld” around each and every tear and hole in the retina.
What Does This Mean?
The scleral buckle has been around for generations. It remains a mainstay of treatment due to its success in repairing retinal detachments.
The modern day vitrectomy has been around for only 30 years, while the present 25 gauge systems have been around less than 10.
My estimation is that a scleral buckle alone or vitrectomy surgery alone is about 90% successful in reattaching the retina. Used in combination, I believe that “success” is somewhere around 95%.
This has now become a highly effective surgery combining both “old” and “new” techniques. Both can usually be performed in an outpatient setting under similar settings. As these techniques become more common place, they are therefore more available to everyone.