Management of superior rhegmatogenous retinal detachment by scleral buckling combined with intravitreal gas injection

Objective To introduce the clinical application of scleral buckling combined with intravitreal gas injection for the treatment of superior rhegmatogenous retinal detachment. Methods In this study, 13 cases of superior rhegmatogenous retinal detachment treated by the same surgeon were selected from January 1st 2015 to April 30th 2017 retrospectively. Among them, there were 9 males and 4 females, aged from 26 to 72 years old. All the patients were healthy and could meet the postoperative posture requirements. Furthermore, the PVR grade was A-B, and the range of separation was at the 8 o'clock-4 o'clock position. Meanwhile, 9 cases of detachment involved the macula, and the remaining cases showed no involvement of the macula. The size of the retinal fissure was about 0.5PD-1.5PD, 10 cases of the retinal fissure were horseshoe-shaped, and the other 3 cases indicated lattice degeneration of the retina. The retinal fissure was observed to be located at the equator or slightly inferior to the posterior pole. Operation with simple external pressure combined with intravitreal gas injection were performed in the 11 cases of patients, and the other 2 patients were treated based on the application of external pressure combined with scleral buckling and intravitreal gas injection. The specific operation procedures were: the conjunctiva was routinely opened during the operation, lifted muscles according to the location of the retinal fissure, the approximate location of the retinal fissure was determined under the binocular indirect ophthalmoscope, partial subretinal fluid were released by sclerotic puncture near the retinal fissure. Afterwards, 0.5-0.8ml sterile filtered gas was injected into the vitreous cavity, the retinal fissure was then frozen under direct vision. Following positioning, the silica gel block was fixed, and external prop pressure was performed subsequently to locate the retinal fissure on the crest of the operation. Postoperative posture coordination was required for surgical patients. Results All operations were successful in 13 cases, anatomic reduction of retina was achieved, 10 cases were followed up for more than half a year without recurrence, another 2 cases were observed to have no recurrence in the follow-up period of 3 months, and the remaining 1 case was followed up for a month without recurrence. All 13 cases had different degrees of vision improvement. Conclusions On the premise of accurately grasping the indication of operation, scleral buckling combined with intravitreal gas injection have a good and definite treatment effect for superior rhegmatogenous retinal detachment. Key words: Scleral buckling; Intravitreal gas injection; Retinal detachment