Ĭonsidering the aforementioned variables, it is questionable whether a consensus about a standardized surgical approach can be reached with enough solid scientific evidence supplied by a randomized controlled trial (RCT), for example. There are several surgical and visualization techniques that can be used to remove as much of the vitreous base as possible: one can either use an external indentation with a regular light-pipe endoillumination or a chandelier, combine a chandelier with an external illuminating source (light pipe with cap), or use the standard operating microscope (opm) without a lens. Traditionally, meticulously vitreous shaving is considered an important step in retinal detachment surgery, since remnants of the vitreous base are associated with an induction of proliferative vitreoretinopathy (PVR). Scleral indentation is usually performed while shaving the vitreous base. Our aim was to address one particular aspect of the surgery: scleral indentation. ![]() In brief, there are many ways to surgically address a retinal detachment however, there is no consensus on the most successful approach. There is also a vivid discussion surrounding the use of endotamponades (gases and silicone oils) and heavy liquids. Some surgeons advocate for a combination of both methods and others prefer cryocoagulation over lasercoagulation, but the majority prefer lasercoagulation. The majority of surgeons are using vitrectomy for most cases, while they perform scleral buckling for selected cases only. Perioperative risk factors that could improve this unfavorable outcome are being investigated at the moment however, no consensus about the best surgical approach has been reached. Although many attempts to improve the re-detachment rate have been performed, it still varies between 10 and 30%. However, re-detachments are still a challenge. The surgical treatment of retinal detachment has improved significantly as a result of the introduction and technical refinement of pars plana vitrectomy. However, many variables play a role in the development of retinal re-detachment, requiring further studies with a larger number of patients. We attribute this to the better visualization of the vitreous base facilitated by endoillumination. The rate of retinal re-detachment could be influenced by the indentation technique at the end of surgery favoring external indentation and internal visualization with an endoilluminator (chandelier light). ![]() ResultsĬomparing both indentation procedures, 15.66% (13/83) of patients operated on by surgeon A and 9.86% (7/71) of patients operated on by surgeon B had a retinal re-detachment within a follow-up period of 6 months (adj. ![]() Surgeon B performed an external 360° indentation, shaved the vitreous base using a simple indentor, and used an endoillumination (light pipe) with the opm and a handheld widefield lens for direct visualization. Surgeon A performed an external 360° indentation, shaved the vitreous base using the light pipe cap, and used the operating microscope (opm) for direct visualization. We included retrospectively 154 eyes with a primary rhegmatogenous retinal detachment treated in the Eye Clinic Sulzbach/Saar Germany, who were operated on by two experienced surgeons using the same basic surgical setup. The aim of this study was to determine whether the choice of scleral indentation technique during primary rhegmatogenous retinal detachment surgery has an influence on the risk of re-detachment.
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