Drainage of subretinal fluid with a radiosurgical instrument: a preliminary report

Modified external needle drainage of subretinal fluid in primary rhegmatogenous retinal detachment: a prospective, consecutive, interventional, single-surgeon study

PURPOSE

We describe surgical outcomes in a single-surgeon, consecutive series of patients who received scleral buckle placement for primary retinal detachment using a modified external needle drainage technique.

METHODS

Eighty-two eyes of 80 patients with primary retinal detachment underwent scleral buckle placement with modified external needle drainage. Preoperative, postoperative, and surgical data were collected. Regression analysis was used to evaluate the association between preoperative clinical data and number of surgeries.

RESULTS

The retinal detachment most commonly involved 41% to 50% of the retina. Seventy-six eyes (92.7%) were repaired after 1 surgical procedure, 98.8%, after 2 procedures, and 100%, after 3 procedures. No preoperative clinical variables were found to be significantly correlated with the number of surgeries performed. Vision improved an average of 0.3 logarithm of the minimal angle of resolution or 3 lines of vision (P < 0.001). One eye (1.2%) developed a localized subretinal hemorrhage at the drainage site that resolved spontaneously.

CONCLUSIONS

The modified external needle drainage technique used during scleral buckle placement appears to be safe and effective in patients with primary retinal detachment.

Modified external needle drainage procedure for rhegmatogenous retinal detachment

PURPOSE

To describe the results of a modified external needle subretinal fluid drainage technique to treat eyes with a rhegmatogenous retinal detachment.

METHODS

One hundred eighty-seven consecutive patients with a rhegmatogenous retinal detachment who underwent scleral buckle and modified external needle drainage at Duke Eye Center or Vistar Eye Associates were included in this study. Subretinal fluid was drained by a technique whereby the intraocular pressure was raised to a supranormal level by tightening an encircling scleral buckle and then the subretinal space was entered by a needle introduced externally while the retina was directly viewed with an indirect ophthalmoscope. Subretinal fluid drainage success rate, one-operation reattachment rate, final retinal reattachment rate, intraoperative and postoperative complication rates, and final visual acuity were the main outcome measures.

RESULTS

Subretinal fluid was successfully drained in all eyes. The one-operation reattachment rate was 91%, and the final reattachment rate was 98%. Intraoperatively, 15% of eyes required corneal debridement to obtain an adequate view for safe subretinal fluid drainage. Subretinal hemorrhage of no more than one clock hour occurred in 4.2% of eyes. A total of 2.6% of eyes developed an epiretinal membrane postoperatively that required a vitrectomy to improve the visual acuity. The postoperative visual acuity, 0.54 by logMAR (20/69 by Snellen), was significantly better than the preoperative visual acuity, 1.1 logMAR (20/250 by Snellen) (P < 0.0001).

CONCLUSIONS

The modified external needle drainage technique is a flexible, effective method to drain subretinal fluid in eyes with a rhegmatogenous retinal detachment. The retinal reattachment rate and complication rate compare favorably to alternative subretinal fluid drainage techniques.

Review: the value of radiosurgery in oculoplastics

PURPOSE

To present the value of radiosurgery in oculoplastic procedures.

METHODS

My experience of 3 years and approximately 1000 oculoplastic procedures using radiosurgery was synthesized. The radiosurgical techniques that I have found useful are presented.

CONCLUSIONS

Radiosurgery is an excellent surgical tool for performing oculoplastic procedures because it coagulates blood vessels as it cuts through tissue. This allows less bleeding during surgery, which translates in better visualization of the tissue planes and a more rapid procedure.