Purpose: There are primarily two techniques for affixing the SCLERAL buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): SCLERAL tunnels or SCLERAL sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using SCLERAL sutures versus SCLERAL tunnels. Pre-and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1. 05 ± 1. 06 (Snellen 20/224) and for the SCLERAL suture cohort was 1. 03 ± 1. 04 (Snellen 20/214, p = 0. 846). The respective mean postoperative logMAR VAs were 0. 45 ± 0. 55 (Snellen 20/56) and 0. 46 ± 0. 59 (Snellen 20/58, p = 0. 574). The single surgery success rate for the tunnel cohort was 87. 3% versus 88. 6% for the suture cohort (p = 0. 601). Three patients (1. 0%) in the SCLERAL tunnel cohort developed postoperative strabismus, but only one patient (0. 1%) in the suture cohort (p = 0. 04, multivariate p = 0. 76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0. 02). There were no differences in vision, anatomic success, or strabismus between SCLERAL tunnels versus SCLERAL sutures in eyes that underwent primary SB. Conclusion: SCLERAL tunnels and SCLERAL sutures had similar postoperative outcomes. Combined PPV/SB in eyes with SCLERAL tunnels might be a risk for strabismus post retinal detachment surgery.

Purpose: To assess the efficacy of minimal surgery SCLERAL buckling in patients who were referred to Labbafinejad medical center in a 5 year period.Material and methods: Records of all patients with retinal detachment who had undergone minimal surgery between 1995 and 2000 and were followed up for at least 6 months were retrospectively reviewed. The records were evaluated with respect to clinical features and disease characteristics and the success rate was determined according to anatomic reattachment and visual acuity of better than 20/200. All intraoperative and postoperative complications were reported. Roles of factors such as extent and duration of retinal detachment, macular status, proliferative vitreoretinopathy, evidence of long standing retinal detachment, type of break, myopia, lens status, intra-operative complications, and cryotheraply on success rate were determined. Regression analysis was used to identify the factors which played the main role in success.Results: Seventy patients (72% male, 25% female) underwent minimal surgery SCLERAL buckling. Mean age (SD) was 44 (17.6) years. Oveall operations were successful (92.9%) and 58 patients have good or useful visual outcome (89.2%). Macular detachment significantly increased the failure rate (P<0.04). Regression analysis showed that the extent of retinal detachment had significant correlation with success rate.Conclusion: The success rate of minimal surgery and final visual acuity in this series were acceptable and similar to other experiences. A controlled clinical trial with a longer period of follow up is recomended to determine role of factors such as duration of retinal detachment and pre-operative visual acuity on anatomic and functional results.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted SCLERAL fixation. If the SCLERAL fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

Purpose: To report a case of bilateral SCLERAL compromise in a male patient with hereditary porphyria cutanea tarda (PCT). Methods: Case report. Results: A 57-year-old male was referred to the Cornea Service at Hospital de Clinicas in Buenos Aires for bilateral SCLERAL thinning. He claimed ocular discomfort and photophobia. Slit-lamp biomicroscopy revealed an oval area of deep SCLERAL thinning without uveal prolapse, adjacent to a conjunctival hyperemic zone in the interpalpebral area, 2 mm temporal to the limbus in the right eye. The left eye presented with a conjunctivalized SCLERAL thinning in the interpalpebral area, 2 mm temporal to the limbus. Physical examination revealed facial hyperpigmentation and hypertrichosis and multiple hypopigmented scars in hands and nails. His family history was positive for PCT. The diagnosis was made by urine porphyrin test and genetic molecular testing. In an attempt to reduce ocular and systemic levels of porphyrins, the patient was treated with oral hydroxychloroquine and repeated phlebotomies, altogether with specially designed glasses to avoid local exposure to sunlight. Conclusions: SCLERAL involvement is a rare manifestation of PCT. An adequate treatment, including interdisciplinary management may ameliorate ocular signs and symptoms.

Purpose: To evaluate corneal topographic changes and induced corneal astigmatism after SCLERAL buckling surgery. Methods: As an interventional case series, patients referred to us from February to November 2002, with rhegmatogenous retinal detachment were scheduled for SCLERAL buckling surgery. The exclusion criteria were: history of pervious SCLERAL buckling, any corneal disease visible on slit lamp biomicroscopy, and any ophthalmic operation in the previous 6 months. According to the extent of surgery, the patients were divided into 4 groups: A) 3600 encircling band + buckling, B) segmental buckling + encircling band, C) radial buckling, and D) local circumferential buckling. Videokeratography was done for all patients before, and then one and 3 months after SCLERAL buckling. Corneal astigmatism, mean keratometry, SRI (surface regulatory index), SAl (surface asymmetry index), PVA (potential visual acuity) were evaluated at each visit. Results: From 56 patients enrolled in this study, 39 patients completed follow up. There were 29 (74.4%) males and 10 (25.6%) females with mean age of 50.35±20years. The patients consisted of 3 (7.65%) in group A, 30 (76.92%) in group B, 4 (10.25%) in group C, and 2 (10.25%) in group D. Statistically significant differences regarding SRI, SAl, PVA (in Log MAR) from baseline measurements were observed in all patients at one and 3 months postoperatively. In spite of increasing corneal astigmatism, there were no statistically significant differences in mean keratometry after SCLERAL buckling surgery. In group B, the results were the same as overall results. In groups A, C, and D the above variables were increased postoperatively. Conclusion: Irregular astigmatism is induced after SCLERAL buckling surgery that remains up to 3 months. It is one of the important causes of decreased visual acuity postoperatively.

SCLERAL buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra‑operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that SCLERAL buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier‑assisted SCLERAL buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional SCLERAL buckling with contemporary vitreoretinal visualization techniques, chandelier‑assistance may increase the popularity of SCLERAL buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.