Chapter 12

Combined Vitrectomy and Scleral Buckle

In some circumstances when a vitrectomy is to be performed, an additional scleral buckle may be considered as a combined procedure. Indications are controversial but may include:

  1. Repeat retinal detachment following vitrectomy only
  2. Proliferative vitreoretinopathy (PVR), particularly if peripheral (and especially if inferior)
  3. Phakic patients (where it is harder to shave the vitreous base and remove sufficient vitreous)
  4. Difficulty visualizing the periphery (vitreous haemorrhage, cortical cataract, posterior capsular opacification)
  5. Inferior breaks (gas or silicone oil endotamponades that float may be less effective)
  6. Significant vitreous base / anterior loop traction (evident during vitrectomy)
Figure 11.3.2 Extruded MIRAgel Episcleral Implant Showing Extensive Swelling Several Years After Implantation

Figure 12.1 Vitrectomy-Scleral Buckle
An encircling band has been passed around the eye prior to vitrectomy. Here the retinal tear can be seen to sit on the indentation of the scleral buckle. The vitrectomy cutter is being used to relieve vitreous traction off the break.

Scleral Buckle or Vitrectomy First?

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