Clinical Ophthalmology (Sep 2022)
A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization
Abstract
Grace Baldwin, Jared T Sokol, Cassie A Ludwig, John B Miller Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USACorrespondence: John B Miller, Retina Service, Mass Eye and Ear, Harvard Medical School, Principal Investigator, Harvard Retinal Imaging Lab, 243 Charles St, Boston, MA, 02114, USA, Tel +1 (617) 573-3750, Fax +1 (617) 573-3698, Email [email protected]: The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP).Methods: A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16).Results: The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0– 0.20) in the ID group and 0.08 (0.02– 0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94– 123) minutes in the ID group and 100 (90– 111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100– 135) minutes vs 93 (85– 111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group.Conclusion: Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.Keywords: endoillumination, heads up visualization, NGENUITY, scleral buckle, light pipe, retinal detachment
