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Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than - 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined.

PurposeThe aim of this study is to review anatomical and functional outcomes following macular buckling (MB) in high myopia and to compare such results with those obtained by pars plana vitrectomy (PPV).MethodsPubMed articles on MB in high myopia (2000–2016) were reviewed. Main outcomes included retinal reattachment and macular hole (MH) closure rates, resolution of myopic foveoschisis (MFS), and postoperative visual acuity.ResultsThirty-one articles included 16 in patients with retinal detachment due to MH (MHRD group), 11 in MFS with or without foveal detachment (MFS group), and 4 in MH patients with MFS (MH-MFS group). Surgical techniques mainly differed in the type of buckle, rectus muscles involvement, and concurrent PPV. In eyes with persistent MH, prognosis in the MHRD and MH-MFS groups differed between eyes receiving MB compared to PPV: functional outcome was markedly poorer and there was a higher risk of retinal redetachment associated with PPV. In the MSF group, secondary MHs were more likely to develop in eyes treated with PPV and internal limiting membrane peeling than those undergoing MB alone or combined with PPV. Retinal pigment epithelium changes, malpositioning, perforation, and choroidal detachment were the main complications.ConclusionsAlthough different approaches are used, complete resolution of foveoschisis, retinal reattachment, and MH closure seem to be achieved more frequently with MB than PPV.

Background To assess the effectiveness of the transconjunctival suprachoroidal buckle (TSCB) technique in treating primary rhegmatogenous retinal detachment (RRD). Methods A prospective interventional study including patients with primary RRD undergoing the TSCB technique. The technique consisted of a transconjunctival approach using an olive tip handled cannula with an Atkinson 25-gauge needle tip that injects a high-purity gel in the suprachoroidal space (SCS) and creates a buckle effect that lasts for 12–18 months. Indirect laser retinopexy is done in the operating room or in the early post-operative office visit on the slit lamp. The TSCB technique could be done in the office in selected cases of uncomplicated RRD. Results The study included 31 eyes of 31 patients. Seventeen eyes were phakic (55%). The RRD involved one quadrant in 81% of eyes. Sixteen eyes (52%) had more than one break. The TSCB procedure was performed in the operating room in 21 patients (68%). The mean duration of follow-up was 5 months. Postoperatively, we achieved retinal attachment in all patients. Three patients (10%) needed a second surgery. Two patients (6%) developed dot hemorrhage due to choroidal puncture. Conclusion The TSCB is safe, and avoids the complications of conventional scleral buckling.

Background Missed fractures are the leading cause of diagnostic error in the emergency department, and fractures of pediatric bones, particularly subtle wrist fractures, can be misidentified because of their varying characteristics and responses to injury. Objective This study evaluated the utility of an object detection deep learning framework for classifying pediatric wrist fractures as positive or negative for fracture, including subtle buckle fractures of the distal radius, and evaluated the performance of this algorithm as augmentation to trainee radiograph interpretation. Materials and methods We obtained 395 posteroanterior wrist radiographs from unique pediatric patients (65% positive for fracture, 30% positive for distal radial buckle fracture) and divided them into train ( n  = 229), tune ( n  = 41) and test ( n  = 125) sets. We trained a Faster R-CNN (region-based convolutional neural network) deep learning object-detection model. Two pediatric and two radiology residents evaluated radiographs initially without the artificial intelligence (AI) assistance, and then subsequently with access to the bounding box generated by the Faster R-CNN model. Results The Faster R-CNN model demonstrated an area under the curve (AUC) of 0.92 (95% confidence interval [CI] 0.87–0.97), accuracy of 88% ( n  = 110/125; 95% CI 81–93%), sensitivity of 88% ( n  = 70/80; 95% CI 78–94%) and specificity of 89% ( n  = 40/45, 95% CI 76–96%) in identifying any fracture and identified 90% of buckle fractures ( n  = 35/39, 95% CI 76–97%). Access to Faster R-CNN model predictions significantly improved average resident accuracy from 80 to 93% in detecting any fracture ( P  < 0.001) and from 69 to 92% in detecting buckle fracture ( P  < 0.001). After accessing AI predictions, residents significantly outperformed AI in cases of disagreement (73% resident correct vs. 27% AI, P  = 0.002). Conclusion An object-detection-based deep learning approach trained with only a few hundred examples identified radiographs containing pediatric wrist fractures with high accuracy. Access to model predictions significantly improved resident accuracy in diagnosing these fractures.

This study aimed to accurately localize retinal tears using computer three-dimensional (3D) reconstruction technology and to validate this method in combination with Foldable Capsular Buckle (FCB) implantation for treating rhegmatogenous retinal detachment (RRD). Assuming a circle passing through the tear, macula, and anterior corneal vertex, computer-aided design (CAD) software calculated half circumferences for varying axial lengths. The distance from the tear's anterior edge to the posterior corneoscleral limbus was derived as the half circumference minus the corneal radius, further subtracting the arc length from the tear to the macula. The chord length from the tear to the macula was converted from the arc length, and breaks were localized by scaling chord lengths using the optic disc's horizontal diameter. For axial lengths of 23.5-30 mm, half circumferences ranged from 36.5-45.5 mm. For arc lengths of 11.5-23.5 mm, corresponding chord lengths were 10-20 mm, with no significant correlation with axial length. Clinically, retinal reattachment was achieved in 42/43 patients (97.7%), with postoperative fundoscopy confirming effective FCB indentation. Visual acuity improved significantly from a preoperative median of 0.10 (range: hand motion to 0.8) to a postoperative median of 0.40 (range: counting fingers to 1.0) (Z = 5.43, p < 0.001), with 88.4% of patients showing improvement. Intraocular pressure (IOP) increased mildly from 12.6 ± 2.7 mmHg preoperatively to 14.7 ± 1.6 mmHg postoperatively (mean increase: 2.1 mmHg; 95% CI: 1.4-2.8 mmHg; t = 5.12, p < 0.001), with all values remaining within the normal range. This simple ruler-based method enables accurate preoperative tear localization and FCB fixation point calculation, providing a practical and effective solution for surgeons performing extraocular buckling procedures.

PurposeTo investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery.MethodsThe files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery.ResultsTen surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve.ConclusionRD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.

Background: Scleral buckling is considered an art, which has a long learning curve compared to other surgical retina techniques. Unfortunately, this beautiful surgical technique is getting less attention as new retina surgeons don't get much exposure to this age-old surgical technique, reason being less interest shown by young retina surgeons and tremendous advancement in micro-incision vitrectomy system.This video is a modification of the present technique of placement of band buckle, which uses science rather than art.The most important aspect in band buckle is getting the optimal buckle height which needs a lot of experience before one can achieve it. Most of the surgeons tend to tighten it more than needed that can lead to complications. This new technique is easy to learn and will give controlled reproducible buckle height and can be done safely by the trainees. Purpose: The aim of this video is to simplify the technique of scleral buckling which can produce controlled and reproducible buckle height and will reduce the complications associated with a tight band buckle. Synopsis: A 360-degree peritomy is made. Four recti muscles are identified and separated and traction sutures are passed under their insertions. A partial thickness scleral tunnel is made in all four quadrants. A silicone band (style#41 used in this video) is passed through the scleral tunnel and under the insertion of all four recti.The two ends of the silicone band are trimmed so that they are opposed to each other. Then a 12-mm strip is cut off from one end, and the two remaining ends are tied with a 5-0 nonabsorbable suture. This technique ensures a 2-mm optimal buckle height. Highlights: We present an elegant technique of placing the band buckle in retinal detachment surgery. Video link: https://youtu.be/9_dh6qsd-7A

Myopia, including pathologic myopia, has seen a significant increase in prevalence in recent years. It is a significant cause of irreversible vision loss worldwide and prediction models demonstrate the substantial future impact on the population. With increased awareness and research, it is possible to prevent blindness on a large scale in the younger, productive age group affected by myopic maculopathy (MM). The vision-threatening manifestations of pathologic myopia include myopic choroidal neovascularization, macular atrophy, maculoschisis, macular hole, and retinal detachment. Myopic traction maculopathy (MTM) is a progressive manifestation of pathologic myopia and its treatment includes pars plana vitrectomy, macular buckle, or a combination. In this article we aim to review the diagnosis, clinical characteristics, and treatment of MM with an emphasis on recent developments in the surgical management of MTM. We discuss commercially available macular buckles, along with potential advantages to the use of macular buckle in MM. We review the new MTM staging system and its role in determining surgical management of these complex cases.

In order to systematically study the bending behavior of the connection joints of the disc-buckle type formwork support, the accurate numerical model of the disc-buckle type connection joints was obtained through the experimental on the bending behavior of the connection joints of the disc-buckle type, and the bending moment-rotation curve of the joints was verified. The analysis of the failure mode and stress distribution of the joints reveals the importance of the bending behavior of each component. By establishing an accurate numerical model of the joint, the accuracy of the bending experiment of the joint was verified, and the parametric analysis of the influence factors such as the depth of the wedge insertion the disk-plate, the initial position of the wedge insertion the disk-plate, the thickness of the wedge, material constitutive of the wedge and the thickness of the disk-plate was carried out to grasp the influence of the relevant parameters on the bending behavior of the joint. The results shown that the connection joints of the disc-buckle type formwork support were a typical semi-rigid connection joints. The thickness of the disk-plate plays a decisive role in the joint bending capacity, and the optimum thickness of the disk-plate was 10 mm. The thickness of the wedge was proportional to the joint bending capacity, and the optimal thickness of the wedge was 7 mm. The drop depth of the wedge should not exceed 6 mm during the locking process and the most suitable yield strength of the wedge was set to 450–500 MPa.