To assess the ease with which retina specialists can place a new titanium scleral buckle designed to indent the posterior pole of the eye. Ten retina specialists with prior experience in placing scleral buckles for retinal detachment repair were selected. Participants sutured a titanium scleral indentation implant (macular buckle, MB) which differs in design and material from commonly used silicone buckles. The new design specifically targets indentation of the posterior pole of the eye, a task that is more difficult to achieve with existing silicone buckles. The study was conducted using pig eyes as a model. Surgeons were given instructions and provided with proper surgical materials. The time taken for each participant to complete the task was recorded. Participants each completed a usability questionnaire after task completion, which focused on the implant’s ease of use, intuitiveness, and the need for additional instructions. All participants completed the task in under 10 min with a median completion time of 5 min [IQR: 5–7.5], and a range of 5–10 min. Participants found the MB intuitive and as easy, if not easier, to suture than existing radial silicone buckles. This ease was attributed to the buckle’s design, which naturally indented the posterior pole without additional manipulation. The study demonstrated that the new titanium MB effectively meets user needs, offering a technique very similar to existing methods but with the advantage of easier posterior pole indentation. The findings highlight the importance of careful suture placement and alignment to maximize procedural efficiency.
Purpose: To analyze anatomic and visual outcomes of young adults with uncomplicated primary rhegmatogenous retinal detachment (RRD) treated with scleral buckle, pars plana vitrectomy (PPV), or combined PPV and scleral buckle. Methods: Patients included in the Primary Retinal Detachment Outcomes study with a minimum of 6 months follow-up were evaluated in this multicenter interventional cohort study,. Patients with complex RRDs were excluded. Primary outcomes were single surgery anatomic success and final visual acuity (VA). Results: Scleral buckle was performed in 91 eyes (55%), PPV in 32 (19%), and combined PPV and scleral buckle in 42 (25%). Single surgery anatomic success rates were 79.3% for PPV alone, 83.7% for primary scleral buckle, and 92.7% for combined PPV and scleral buckle (analysis of variance, P = .25). When adjusting for potential risk factors, eyes that had PPV alone were more likely to redetach compared with those that had combined PPV and scleral buckle (hazard ratio [HR], 7.24, 95% CI, 1.25-42.1; P = .03), while rates of redetachment were similar in eyes that had scleral buckle alone and combined PPV and scleral buckle (HR, 3.24, 95% CI, 0.63-16.63; P = .16). However, eyes that had combined PPV and scleral buckle were less likely to result in good vision compared with eyes that had scleral buckle alone (odds ratio [OR], 0.26, 95% CI, 0.07-0.94; P = .04). Similarly, eyes that had PPV alone were less likely to obtain good vision compared with eyes that only had scleral buckle (OR, 0.20, 95% CI, 0.05-0.81; P = .02). Conclusions: For young adults in this study, the best visual outcomes resulted from scleral buckle, and a higher single surgery success rate was found with combined PPV and scleral buckle.
As Immune checkpoint inhibitors are being expanded for use in gynecologic malignancies, rare immune-related adverse events are more frequently being reported. Here we describe a 63-year-old with Stage IIIB mismatch repair deficient uterine adenocarcinoma who underwent six cycles of carboplatin and paclitaxel with partial response but persistent disease. She was then started on single agent pembrolizumab. After six cycles of pembrolizumab, she developed bilateral vision changes and was diagnosed with posterior scleritis. Pembrolizumab was held and she was treated with oral prednisone, with rapid resolution of symptoms. One month after completion of prednisone, vision changes were again reported and she was restarted on a longer oral prednisone course. She then underwent definitive surgical management consisting of a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy, with final pathology of benign endometrial hyperplasia. She has completed her steroid course without any symptoms. Given her complete pathologic response, she was subsequently placed into surveillance and is currently without evidence of disease. Prompt recognition and treatment of this rare immune-related adverse event led to the prevention of potential permanent, debilitating outcomes.
