Korean J Ophthalmol.  2018 Apr;32(2):126-133. 10.3341/kjo.2017.0092.

Scleral Buckling under a Slit-lamp Illumination System with a Contact Wide-angle Viewing Lens Compared with an Indirect Ophthalmoscope

• Choi SY
• Lee Y
• Kim M
• Park YH

• KMID: 2408952
• DOI: http://doi.org/10.3341/kjo.2017.0092

Abstract

PURPOSE
To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope.
METHODS
By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups.
RESULTS
Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001).
CONCLUSIONS
Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.

Keyword

Indirect ophthalmoscope; Retinal detachment; Scleral buckling; Slit lamp

MeSH Terms

Drainage
Electronic Health Records
Humans
Jupiter
Lighting*
Ophthalmoscopes*
Retinal Detachment
Retrospective Studies
Scleral Buckling*
Slit Lamp
Subretinal Fluid
Visual Acuity

Figure

• 

  Fig. 1 Surgical photographs of scleral buckling surgery performed using slit-lamp illumination combined with a contact wide-angle viewing system for rhegmatogenous retinal detachment. (A) A general view of retinal detachment before scleral buckling surgery. (B) The retinal tear site with scleral indentation (arrow). (C) Whitening of the retina during cryopexy (arrow). (D) Successful application of a buckling band on tear site (arrow) after tightening of the fixation scleral suture.

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