Scleral buckling under a slit-lamp illumination system in patients with primary rhegmatogenous retinal detachment

Purpose To present the slit-lamp illumination and visualisation system for scleral buckling for primary rhegmatogenous retinal detachment (RRD) and assess its feasibility and postoperative outcomes. Methods In a retrospective, single-center, non-comparative case series, patients with subtotal RRD who underwent scleral buckling under a slit-lamp illumination system at Lariboisière Hospital, between May 2017 and May 2022, were included. Patients who underwent scleral buckling combined with vitrectomy, with a history of retinal surgery and with maculopathies interfering with visual acuity were excluded. The following preoperative data were collected: best-corrected visual acuity (BCVA), number and location of retinal breaks, extend of the detachment, presence of macular detachment. The fundus was visualised using a quadraspheric lens, and the slit-lamp system integrated in the surgical microscope. Anatomical success rate, BCVA improvement and complications were collected. Results Forty-six eyes of 46 patients with a mean age of 43.2 ± 12.8 years, followed for 8.7 ± 8.3 months were included. No procedure was switched to vitrectomy during surgery. The single surgery success rate was 93.5% (43 eyes). Three eyes had to undergo vitrectomy due to vitreoretinal proliferation. BCVA improved from 0.63 ± 0.76 LogMAR (Snellen 20/80) before surgery to 0.33 ± 0.40 LogMAR (Snellen 20/40) after surgery (p=0.002). Intraoperative and postoperative complications were experienced by two and nine patients, respectively. Conclusion Scleral buckling using a surgical microscope with an integrated slit-lamp and a wide-angle contact lens is a feasible technique associated with satisfactory anatomical and functional outcomes. This approach was associated with a high single-surgery success rate and a manageable complication rate. Clinical trial number Not applicable.