CHANDELIER-ASSISTED VERSUS STANDARD SCLERAL BUCKLING FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: A Randomized Clinical Study.

PURPOSE: To compare anatomical outcomes, functional outcomes, and rate of complications of standard scleral buckling (SSB) versus chandelier-assisted scleral buckling (CSB) in phakic eyes with rhegmatogenous retinal detachment. METHODS: Patients were randomly assigned to either SSB or CSB. Surgical success/failure rate, corrected distance visual acuity, surgical operating time, and rate of intraoperative and postoperative complications including epiretinal membranes by spectral domain optical coherence tomography were compared between groups. RESULTS: A total of 50 eyes of 49 patients were included. At 6 months, there was no statistically significant difference between groups in primary success, or final anatomical success ( P > 0.9); mean corrected distance visual acuity at any visit ( P values >0.05); or mean surgical time: 120.3 ± 39.05 and 102.48 ± 43.76 minutes for the SSB and CSB, respectively ( P = 0.1). The CSB had a higher rate of postoperative complications (34.8%) compared with the SSB (3.8%) ( P < 0.05). On spectral domain optical coherence tomography, CSB had a statistically significant higher rate of epiretinal membranes compared with SSB (44% vs. 19% [ P < 0.05]) and showed vitreous entrapment in the chandelier sclerotomy site on the ultrasonic biomicroscopy. CONCLUSION: Chandelier-assisted scleral buckling surgery does not offer encouraging advantages over SSB. On the contrary, we detected a higher rate of complications with CSB especially epiretinal membranes development.

Long-term changes in ocular rigidity following scleral buckling for rhegmatogenous retinal detachment.

PURPOSE: To investigate the long-term effect of scleral buckling on corneal biomechanics and the effect of change of scleral properties on intraocular pressure (IOP) measurements. METHODS: This is a prospective case series, patients with rhegmatogenous retinal detachment prepared for scleral buckling were included. Goldmann applanation tonometry was used to measure IOP (GAT IOP). Ocular Response Analyzer (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), goldmann-corrected IOP (IOPg), and corneal-compensated IOP (IOPcc) preoperatively, and 1, 3, and 6 months postoperatively. RESULTS: Thirty-three eyes included in the final analysis, with an average age 38.4 ± 16.2 years. CH and CRF decreased significantly at first, third, sixth months post-scleral buckling; however, this effect decreased with time as follows; preoperative: 8.9 ± 1.5 and 8.5 ± 2.1, first month: 6.8 ± 1.6 and 7.1 ± 1.8 (P value = 0.00, 0.002), third month: 7.8 ± 1.5 and 7.6 ± 1.6 (P value = 0.001, 0.008), and sixth month: 7.7 ± 1.3 and 7.6 ± 1.7 (P value = 0.002, 0.055). IOP cc was 19.3 ± 3.6, 17.1 ± 4, and 17.6 ± 2.9 at 1, 3, and 6 months, and these readings were significantly higher than GAT (13.6 ± 7.6, 12.4 ± 5.1, and 12.1 ± 2.9, P values = 0.00) and IOPg (14.9 ± 3.6, 13.5 ± 4.1, and 13.9 ± 3.5, P values = 0.00). The change in CH at each visit is correlated with the difference between the IOPcc and GAT measurements. CONCLUSION: The conventional Goldmann applanation tonometry underestimates post buckle IOP measurements due corneal biomechanics changes. ORA might be an alternative and accurate method of measurement; however, further investigation is warranted.