https://whatsapp.com/channel/0029Va9r420CBtxIW9j9IE2S

1. Dr.Pushkar Dhir
DHIR EYE HOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY
BHIWANI HARYANA

2. BUCKLING FOR THE
MANAGEMENT OF RHEGMATOGENOUS
RETINAL DETACHMENTS SECONDARY
TO PERIPHERAL RETINAL BREAKS

6. SUPRACHOROIDAL BUCKLING FOR
THE
MANAGEMENT OF RHEGMATOGENOUS
RETINAL DETACHMENTS SECONDARY
TO PERIPHERAL RETINAL BREAKS
EHAB N. EL RAYES, MD, PHD,* MIKEL MIKHAIL, MD,† HALA EL CHEWEIKY, MD, PHD,‡
KAREEM ELSAWAH, MD,* ANDRE MAIA, MD, PHD§
RETINA 37:622–629, 2017
Presentor:- Pushkar Dhir

7. • The basic principle of surgery is to find all retinal breaks, treat them, and relieve
vitreous traction.
• Inability to address one or all of these objectives is often the cause of early surgical
failure.
• Despite advances in modern vitreoretinal surgery, scleral buckling remains an
effective modality for the treatment of uncomplicated rhegmatogenous retinal
detachments; particularly those associated with inferior breaks, as well as in the
younger, phakic, and myopic populations
• Though scleral buckles are associated with clinically significant complications, --
-inadvertent globe perforation, strabismus, induced myopic astigmatism, and
ischemic changes, as well as buckle extrusion and Infection
• The suprachoroidal space can be used to appose choroid to retina, thereby avoiding
many of the complications associated with episcleral buckling.
• This study highlights technique of creating a suprachoroidal buckle, using the
choroid alone to close a retinal break, and report outcomes associated with this
treatment modality.

8. To evaluate functional and anatomical outcomes of eyes undergoing suprachoroidal
buckling for the management of peripheral retinal breaks in rhegmatogenous retinal
detachment.
• 41 eyes of 41 patients undergoing suprachoroidal buckling for the management of RRD
secondary to single or multiple retinal breaks.
• Suprachoroidal indentation was achieved through the introduction of filler material using a
23-gauge (23-G) olive-tipped, suprachoroidal cannula.
• This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition.
• Healon5 (Abbott Medical Optics) was used as filler material in all eyes.

9. • Only eyes with a minimum follow-up period of one year were included.
• 26 undergoing suprachoroidal buckling using Restylane Perlane (Galderma
Laboratories, Fort Worth, TX) and/or using a 20-G suprachoroidal cannula were
excluded.
• All patients were evaluated 1 day, 1 and 2 weeks, and 1 month postoperatively.
• Thereafter, patients were assessed at 3-month intervals for a minimum followup period of 1
year.

10. • A 25-G chandelier light was placed at the 12-o’clock position if the tear was inferior,
at 6-o’clock if the tear was superior.
• Fundus examination done with wide angle viewing system mounted on the operating
microscope.
• Peripheral breaks were identified under direct illumination from the chandelier.
• The cryotherapy probe was then used to treat the breaks in 37 eyes (90.2%),
whereas indirect laser was used in 4 eyes (9.8%), to create chorioretinal adhesion.
• Cryotherapy was applied prebuckle, whereas laser was applied after the buckle was
formed.
• Conjunctival incision performed 4 mm from the limbus in the quadrant of the retinal
break. A lamellar thickness sclerotomy was then fashioned.
• . Viscoelastic material was then injected at the posterior lip of the scleral wound to
displace the choroid, thereby creating a suprachoroidal pocket.
• A 23-G olive-tipped cannula (El-Rayes Curved Suprachoroidal Cannula; MedOne
Surgical, Sarasota, FL) was then introduced through the posterior scleral.

14. • Mean visual acuity gain was the primary outcome measure.
• Final retinal reattachment rate, single-surgery reattachment rate, and
complications were secondary outcome measures.
• Mean best-corrected distance visual acuity improved from 20/1,100 to 20/42.
• Single surgery reattachment rate was 92.7% (38/41 eyes). Final retinal
reattachment was achieved in all 41 eyes (100%).
• There was no statistically significant difference in visual acuity gain or anatomical
reattachment in terms of retinal break quadrant or extent.
• No major complications were observed. Two localized suprachoroidal
hemorrhages occurred at the entry site for the cannula. These resolved without
further intervention.

16. • The suprachoroidal space is a potential space that is approximately 30
micro m thick, consisting of collagen fibers, elastic fibers, fibrocytes,
melanocytes, ganglion cells, and nerve filaments.
• The anterior space has been successfully harnessed surgically through
minimally invasive glaucoma stents to create a controlled cyclodialysis
cleft.
• It is also becoming the site of increasing interest as a portal for the
administration of medications to the posterior segment
• There were no cases of migration of viscoelastic material within the
suprachoroidal space.
• In addition, the material was well tolerated with no proinflammatory signs.
In fact, high molecular weight viscoelastic material has been shown to
inhibit phagocytosis and cellular migration

17. • Suprachoroidal buckling allows the surgeon to reach target tissue independent of
location.
• The curved cannula can be guided to up to 3 clock hours on either side of the entry
site to allow for filler injection at the site of single or multiple breaks.
• A circumferential buckle of up to 180° can therefore be created.
• This is particularly useful in inferior or sub-silicon retinal detachments, where
circumferential retinal support is often required. The olive tip also serves as an
effective choroidal depressor.
• A particular advantage of our technique is the ability to modify the buckle height and
location.
• The former is achieved through controlled injection of filler, whereas the latter is
performed through navigation in the suprachoroidal space, guided by the depressor
effect of the olivetipped cannula.
• The surgeon can therefore be in control of the extent of the buckling effect desired,
ensuring accurate localization

19. • THANK YOU EVERYONE FOR PATIENTLY LISTENING TO THIS PRESENTATION
• For feedbacks & brickbats plz mail at
• drdhir2014@gmail.com/ykush@yahoo.co.in

21. Our Discussion /Contact/Minutes
• How was ur experience with superior breaks?
• With gasses compression ,was there a
migration of filler?
• mikel.mikhail@mail.mcgill.ca
• https://eyetube.net/video/suprachoroidal-
buckling-with-an-olive-shaped-25-gauge-
cannula/