OSLI Retina

March/April 2013

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■ E X P E R I M E N T A L S C I E N C E ■ Scleral Electrocautery and its Effects on Choroid Vessels: Implications for Subretinal Fluid Drainage During Scleral Buckling Surgery C. Nathaniel Roybal, MD, PhD; Irena Tsui, MD; Christian Sanfilippo, MD; Jean-Pierre Hubschman, MD INTRODUCTION BACKGROUND AND OBJECTIVE: External drainage of subretinal fluid as part of a scleral buckling procedure rapidly restores the retinal pigment epithelium–neural retina interface in rhegmatogenous retinal detachments but carries the inherent risk of subretinal hemorrhage and retinal incarceration. The authors investigated variations to the technique to reduce the chance of subretinal hemorrhage originating from the choroid. MATERIALS AND METHODS: A novel method for needle drainage using electrocautery of the sclerochoroidal layers before puncture was employed. The effect of 0% to 50% scleral electrocautery in a porcine model was investigated. RESULTS: A significant decrease in choroidal vessel diameter and choroidal vessel density at 40% electrocautery was demonstrated. CONCLUSION: Electrocautery without scleral cutdown before external drainage of subretinal fluid likely decreases the chance of subretinal hemorrhage by decreasing choroidal vascularity. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:176-180] Retinal detachments are relatively common eye emergencies, with an estimated incidence of 12.4 per 100,000 persons.1 The majority of these detachments undergo surgical repair with either scleral buckling, pars plana vitrectomy, or both. The decision regarding how to repair a scleral buckle is both surgeon- and resource-dependent. Drainage of subretinal fluid during scleral buckling surgery has multiple indications and variations in surgical techniques.2 The clinical utilization of subretinal fluid drainage is dictated by surgeon preference and the potential intraoperative complications of retinal incarceration and subretinal hemorrhage. Classically, a two-step scleral cut-down technique is used to drain subretinal fluid. The technique employs a 3-mm scleral incision to expose the choroid, which is then cauterized with diathermy before needle penetration.2 The severe but uncommon complications of this technique include subretinal hemorrhage and retinal or vitreous incarceration.3 In an effort to decrease complications, there have been innovations to this procedure, including visualization with indirect ophthalmoscopy, simultaneous buckle tightening, bending the needle, guarding the needle, and laser penetration.4-8 The scleral buckle tightening technique described by Jaffe et al limits subretinal hemorrhage by elevating intraocular pressure.6 The elevated intraocular pressure is not without complication, the resultant corneal edema necessitates cor- From the Jules Stein Eye Institute, University of California, Los Angeles, California. Originally submitted March 20, 2012. Accepted for publication November 28, 2012. Posted online February 28, 2013. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Irena Tsui, MD, 100 Stein Plaza, Los Angeles, CA 90095; 310-825-7290; Fax: 310-794-7905. Email: itsui@jsei.ucla.edu. doi: 10.3928/23258160-20130213-02 176 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina

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