The surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment_Chinese Journal of Ocular Fundus Diseases

Authors：

Chen Chunli , Jin Haiying , Tian Tian , Zhu Xiuyu , Peng Jie ,  Zhao Peiquan

Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai 200092, China (Chen Chunli, now working at Department of Ophthalmology, Shengli Oilfield Central Hospital and Department of Ophthalmology, Tianjin Medical University Eye Hospital);

Corresponding author：

Zhao Peiquan, Email: zhaopeiquan@126.com

Keywords：

segmental buckling/technique; retinal detachment/surgery

DOI：

10.3760/cma.j.issn.1005-1015.2018.02.004

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Objective To observe the surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case series. Seventy-six patients (78 eyes) with uncomplicated RRD who underwent the modified transconjunctival technique for minimal segmental buckling were enrolled in this study. There were 41 male (42 eyes) and 35 female (36 eyes). The average age was (33.9±15.6) years. Best corrected vision acuity (BCVA), fundus examination with three-mirrors lens, ocular B ultrasound, optical coherence tomography (OCT) were performed in all patients. BCVA was examined through Standard logarithmic visual acuity chart and transferred to logMAR vision for statistical analysis. The logMAR BCVA was 0.88±0.88. The technique was successfully performed in all 78 eyes. After transconjunctival location of the retinal break was made, a 5 to 6 mm radial conjunctival incision was performed corresponding to the retinal break without cutting the limbal conjunctiva–Tenon’s capsule. After cryopexy, a minimal explant was fixed with one to two sutures through the conjunctival opening, expanded by a pediatric speculum. BCVA, intraocular pressure, tear film stability, conjunctival recovery and retinal reattachment were collected 1 week, 1 month, 3 months, 6 months after surgery. Results One week after surgery, retinal reattachments were achieved in 77 of 78 (98.7%) eyes and 1 eye (1.3%) received vitrectomy. Compared before surgery, the logMAR BCVA improved to 0.44±0.41, with significant difference (t=3.092, P＜0.01). Conjunctival incision tear occurred in 1 eye. Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure. Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure. Hemorrhage was absorbed in 2 of the 5 eyes at 3 months after surgery and absorbed in all 5 eyes at 6 months after surgery. Subretinal fluid occurred in 10 eyes at 1 week after surgery and be absorbed completely at 6 months after surgery. Tear film stability improved to preoperative lever at 1 week after surgery. Less change in corneal and conjunctival sensitivity was observed in all eyes. No other surgical complications were observed within the follow-up period, such as scleral perforation, explant extrusion, diplopia or infection. Conclusions The modified transconjunctival technique for minimal segmental buckling minimizes the damage to conjunctiva without reducing the retinal reattachment rate. It can effectively treat uncomplicated RRD with preserving an intact limbal conjunctiva and rapid tear film stability recovery.

Citation： Chen Chunli, Jin Haiying, Tian Tian, Zhu Xiuyu, Peng Jie, Zhao Peiquan. The surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment. Chinese Journal of Ocular Fundus Diseases, 2018, 34(2): 120-123. doi: 10.3760/cma.j.issn.1005-1015.2018.02.004 Copy

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1. Jin H, Zhang Q, Zhao P.Minimal in situ conjunctival incision for segmental scleral buckling surgery[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 574-576. DOI: 10.3928/23258160-20141118-14.
2. 陈春丽, 宋宗明, 郑景伟, 等. 巩膜扣带术后早期泪膜变化的临床研究[J]. 眼科新进展, 2011, 31 (8): 754-757.Chen CL, Song ZM, Zheng JW, et al. Clinical study on early changes of tear film after scleral buckling surgery[J]. J Clin Ophthalmol, 2011, 31(8): 754-757.
3. The difinition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop(2007)[J]. Ocul Surf, 2007, 5(2): 75-92.
4. Cho YK, Kirn MS. Dry eye after cataract surgery and associated intraoperative risk factors[J]. Korean J Ophthalmol, 2009, 23(2): 65-73. DOI: 10.3341/kjo.2009.23.2.65.
5. Schepens CL, Okamura ID, Brockhurst RJ. The scleral buckling procedures.Ⅰ.Surgical techniques and management[J]. Arch Ophthalmol, 1957, 58(6): 797-811.
6. Custodis E. Bedeutet die Plombenaufnaehung auf die Sklera einen Fortschritt in der operativen Behandlung der Netzhautabloesung?[J]. Ber Zusammenkunft Dtsch Ophthalmol Ges, 1953, 58: 102-105.
7. Lincoff HA, Baras I, McLean J. Modifications to the Custodis procedure for retinal detachment [J]. Arch Ophthalmol, 1965, 73: 160-163.
8. 高磊, 崔蕾, 刘广森. 改良巩膜扣带手术治疗孔源性视网膜脱离的疗效观察[J]. 中华眼底病杂志, 2017, 33(4): 411-412. DOI: 10.3760/cma.j.issn.10045-1015.2017.04.021.Gao L, Cui L, Liu GS.The clinical efficacy of modified scleral buckling surgery for rhegmatogenous retinal detachment[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 411-412. DOI: 10.3760/cma.j.issn.10045-1015.2017.04.021.
9. Lincoff H, Kreissig I.The treatment of retinal detachment without drainage of subretinal fluid (modifications of the Custodis procedure, Part Ⅵ)[J]. Trans Am Acad Ophthalmol Otolaryngol, 1972, 76(5): 1221-1232.
10. Lincoff HA, Kreissig I, Hahn YS.A temporary balloon buckle for the treatment of small retinal detachments[J]. Ophthalmology, 1979, 86(4): 586-596.
11. Shimada Y. Retractor with radial incision for scleral buckling[J]. Retina, 2011, 31(9): 1974-1976. DOI: 10.1097/IAE.0b013e318233ab7c.

Chinese Journal of Ocular Fundus Diseases

The surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment

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