Non-contact wide-angled visualization with chandelier-assisted scleral buckling for primary uncomplicated rhegmatogenous retinal detachment.

PURPOSE: To report our experience in non-contact wide-angled visualization with chandelier-assisted scleral buckling (SB) in uncomplicated primary rhegmatogenous retinal detachments (RRD). METHODS: Retrospective case series of 282 eyes that underwent non-contact wide-angled visualization with chandelier-assisted SB and were followed for a mean of 13.5 months. RESULTS: There were 160 male patients. The average age was 42.6 years old. There were 262 eyes that were phakic, 18 pseudophakic, and 2 aphakic. Two-thirds of eyes presented with the macula detached. Eyes had an average of 1.6 breaks. The single operation anatomic success rate was 85.1% (240/282). The pre-op visual acuity improved from 1.21 to 0.76 logMAR at 6 months (p < 0.0001). Complications included a case of scleral laceration, choroidal hemorrhage, 3 epiretinal membranes, 1 macular fold, and 4 eyes with buckle exposure. CONCLUSION: Non-contact wide-angled visualization with chandelier-assisted SB compares favorably with conventional SB for primary uncomplicated primary RRD.

Scleral punch method with topical mitomycin C for safe revision of failed deep sclerectomy in nanophthalmic uveal effusion syndrome.

PURPOSE: To describe a novel surgical technique for revision of deep sclerectomy surgery in nanophthalmic uveal effusion syndrome. METHODS: A 46-year-old woman with recessively inherited nanophthalmos and chronic uveal effusions underwent a revision of previous failed deep sclerectomy surgery. In the presence of scar tissue, revision of sclerectomies was greatly facilitated by the use of a Kelly scleral punch (Katena Products, Inc., Denville, NJ, USA). To inhibit further scarring, mitomycin-C (MMC) was applied topically in each quadrant posterior to the equator. RESULTS: The scleral punch allowed outward scleral dissection from the suprachoroidal space, and brisk enlargement of sclerectomies in all quadrants without perforation of choroidal tissue. Post-operative conjunctival wound healing appeared unimpeded by the posteriorly placed MMC sponges. Near-total resolution of the effusions had occurred by 3 months. CONCLUSIONS: The scleral punch provides a safe and effective method for constructing and revising full-thickness sclerectomies in the nanophthalmic eye, minimizing the risk of choroidal trauma. The use of topical MMC may reduce the risk of late failure of trans-scleral outflow due to fibrosis.

Combined phacoemulsification and removal of gas following macular hole surgery.

We describe a technique for combined fluid-gas exchange and phacoemulsification 2 weeks after macular hole surgery to achieve rapid visual rehabilitation. The procedure uses a standard cataract set and requires minimal vitreoretinal expertise. We encountered no significant complications and obtained long-term outcomes comparable to those with conventional management.