A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization

Grace Baldwin; Jared T Sokol; Cassie A Ludwig; John B Miller

doi:10.2147/OPTH.S378179

A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization

Clin Ophthalmol. 2022 Sep 19:16:3079-3088. doi: 10.2147/OPTH.S378179. eCollection 2022.

Authors

Grace Baldwin¹, Jared T Sokol¹, Cassie A Ludwig¹, John B Miller¹

Affiliation

¹ Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.

Abstract

Purpose: The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP).

Methods: A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16).

Results: The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0-0.20) in the ID group and 0.08 (0.02-0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94-123) minutes in the ID group and 100 (90-111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100-135) minutes vs 93 (85-111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group.

Conclusion: Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.

Keywords: NGENUITY; endoillumination; heads up visualization; light pipe; retinal detachment; scleral buckle.

Grants and funding

Funding supported in part by the Office of Scholarly Engagement, Program in Medical Education, Harvard Medical School (GB) and funding provided through the Ronald G. Michels Fellowship Foundation Award (CAL).