Vitrectomy v.s. scleral buckle

[retinasurgeon]

I know that vitrectomy surgery has become the more common surgery for retinal detacment surgery. I would like to ask anyone who has done a surgical retina fellowship if this was the case during their training. Whether they would do a vitrectomy on a case where a scleral buckle would have suffice. I still did a fair amount of scleral buckle surgery during my fellowship 4 years ago, and still consider it a good surgical procedure, as is pneumatics.

I have observed from some colleagues here in my country that they tend to do vitrectomy or vitrectomy + scleral buckle in all their retinal detachment cases.

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[PDT4CNV]

I'm still in my fellowship, but I can say that most of our RD patients are repaired using vitrectomy techniques, or vitrectomy + buckle

There are 9 retina attendings that operate at our facility, it is rare for any of them to do a primary buckle. The occasional young phakic myope with closely spaced breaks may get a segmental buckle +/- external drainage as their primary procedure.

I agree that SB is a good procedure, and probably becoming a lost art. The young phakic RD is where it is probably best applied as a primary procedure. I'm sure you saw Dr. Heimann's article in 12/07 Ophthalmology.

 

[retinasurgeon]

I'm still in my fellowship, but I can say that most of our RD patients are repaired using vitrectomy techniques, or vitrectomy + buckle

There are 9 retina attendings that operate at our facility, it is rare for any of them to do a primary buckle. The occasional young phakic myope with closely spaced breaks may get a segmental buckle +/- external drainage as their primary procedure.

I agree that SB is a good procedure, and probably becoming a lost art. The young phakic RD is where it is probably best applied as a primary procedure. I'm sure you saw Dr. Heimann's article in 12/07 Ophthalmology.

It was one of the reasons I asked this question. . Actually, in my practice, I do around 150 - 200 VR cases per year, with around 1/3 of them for retinal detachments, and I did primary buckle in around 3 - 5 cases only. Also, I'm not a fan of pneumatics. (did less than 5, I think). The rest are either a primary vitrectomy (phakics with the break a wee bit posterior) or combined with a buckle (multiple breaks, phakic with multiple breaks and some PVR, or multiple breaks at different level on the retina, PVR, chronic RDs). Usually place a 240, 41 or 42 band, or very rarely, if there is really bad PVR, a silicone tyre (style 276 or 287) + oil.

I do agree that scleral buckling is becoming a lost art, but it would still be nice for fellows to learn it as a primary surgery for select cases (Phakic eyes with inferior detachments, infero-temporal dialysis, or superior retinal breaks not widely spaced out with RD). I still do belt loops instead of sutures when I use bands, but in the presence of scleral ectasia or PVR, I would rather use Nylon or Dacron.. I usually don't drain, but I inject a small bubble if the breaks are superior, or drain and sometimes inject a small bubble, just to help change the vitreous dynamics inside the eye if the patient is phakic

 

[PDT4CNV]

Well, I think the frequency of buckleing techniques used varies greatly from center to center.

My two primary fellowship preceptors, one trained with Machemer at Bascom while vitrectomy techniques were developing and the other with Steve Charles, so there is definitely a bias toward vitreoretinal techniques over SB in my fellowship.

Regarding pneumatics, I am not a big fan. It seems to be used most frequently in areas where OR time is more difficult to come by.

 

[retinasurgeon]

Well, I think the frequency of buckleing techniques used varies greatly from center to center.

My two primary fellowship preceptors, one trained with Machemer at Bascom while vitrectomy techniques were developing and the other with Steve Charles, so there is definitely a bias toward vitreoretinal techniques over SB in my fellowship.

Regarding pneumatics, I am not a big fan. It seems to be used most frequently in areas where OR time is more difficult to come by.

Where's your program? There really is a bias towards vitrectomy. . Your preceptors came from the very pioneers of modern VR surgery. I had 4 preceptors, 2 trained in Barnes (WUSTL), 1 trained with Stanley Chang, and the head of our fellowship trained in Wilmer with Bert Glaser.

I remember during my interview circuit 5 years ago that there's this program that does a lot of pneumatics as primary. It's a very high volume program though. Ended up in U of Toronto. Did only a few pneumatics for RDs, as we are more biased for vitrectomy or occasionally SBs.

Don't know if this is true, but I think pneumatics are more common during the weekends.

 

[rubensan]

Regarding pneumatics, I am not a big fan. It seems to be used most frequently in areas where OR time is more difficult to come by.

What if the break is superior and the pt is phakic?