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Controversies |

Scleral Buckling vs Vitrectomy The Continued Role for Scleral Buckling in the Vitrectomy Era

Edwin Hurlbut Ryan Jr, MD; Robert Ajit Mittra, MD
Arch Ophthalmol. 2010;128(9):1202-1205. doi:10.1001/archophthalmol.2010.192.
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Scleral buckling (SB) with an episcleral exoplant was first performed as a technique to repair rhegmatogenous retinal detachment (RD) by Custodis in 19491 and was popularized in the 1950s.2,3 Until the introduction of pars plana vitrectomy (PPV) in the early 1970s by Machemer et al,4 SB was the only significant treatment alternative for RD. Soon after its introduction, PPV enhanced the ability to repair RDs, particularly in settings of complex cases,5,6 trauma,7,8 and proliferative vitreoretinopathy (PVR).911 The use of PPV has expanded in the repair of RDs, particularly in patients with pseudophakic eyes.12,13 As instrumentation and safety of PPV continue to improve along with modern microscopes and wide-angle viewing systems, some have suggested that PPV should be used alone for nearly all rhegmatogenous RDs. We assert that surgeons should offer the procedure most likely to repair the RD in a single session with the lowest risk of severe complications and with the best chance that a second operation will be successful should the first fail. In this light, we would argue that, although PPV alone has a role in the treatment of selected rhegmatogenous RDs, most would be best repaired with SB alone or SB plus PPV.

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