Endoscope-assisted scleral buckle procedure
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nternational Journal of Retina and Vitreous Open Access
CASE REPORT
Endoscope‑assisted scleral buckle procedure Sean M. Platt1,2 and Andrew J. Barkmeier1*
Abstract Background: Retinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. Select patients may benefit most from primary scleral buckling without vitrectomy, but lack adequate posterior segment ophthalmoscopic visualization to use standard techniques. Case presentation: The authors describe a retinal reattachment technique utilizing endoscope-assisted visualization to perform a primary scleral buckle procedure for a 34yo female with Peters’ Anomaly and a macula-sparing retinal detachment. Retinal reattachment was achieved with a single procedure and she remained stable with preservation of baseline visual acuity at 30 months follow-up. Conclusion: In cases where a primary scleral buckle procedure is the preferred retinal detachment repair technique but posterior segment visualization is limited, intraoperative fundus examination, cryotherapy administration, and scleral buckle positioning can be facilitated with intraocular endoscopy. Keywords: Endoscope, Scleral buckle, Retinal detachment, Peters’ anomaly Background Retinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. At times, opacification of the anterior segment ocular media must be addressed during vitreoretinal surgery, either via techniques aiming to clear the media (e.g. lensectomy, corneal epithelial scraping, temporary keratoprosthesis), or potentially through the use of endoscopic visualization to bypass the anterior segment. We describe a technique that was developed to perform retinal reattachment surgery on a 34 year old female with Peters’ Anomaly, microcornea, nystagmus, and ocular hypertension. She presented with acute vision changes and was diagnosed with macula-sparing retinal detachment on B-scan ultrasonography. Visual acuity was preserved at her 20/300 baseline. She was monocular following multiple surgeries in her fellow eye including trabeculectomy, penetrating keratoplasty, multiple retinal *Correspondence: [email protected] 1 Department of Ophthalmology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA Full list of author information is available at the end of the article
detachment surgeries, and eventual enucleation. A primary scleral buckle operation was preferred for several reasons, but anterior segment pathology including corneal scarring, cataract, and iris anomalies did not permit sufficient ophthalmoscopic visualization of the peripheral retina.
Surgical technique Prior to surgery, meticulous ultrasonography was performed with attention to the boundaries of detached retina, as well as to any areas concerning for vitreoretinal pathology. This step is critical for determining the optimal trocar cannula placement to facilitate localization and treatment of retinal breaks, and to minimize the risk of crystalline lens trauma from the endoscope. A standard 360°
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