![]() For example, for sponges, the assistant can pull both ends of the sponge so the sponge is thinned. The element is passed under the suture loops and relevant rectus muscles.Ī variety of techniques can be used to tighten the sutures around the buckle element and ensure imbrication. Drainage is best performed after placement of all sutures to avoid passing sutures in a soft globe, which risks perforation, and before placement of the buckle element, which (except for low profile encircling buckles) can crowd the surgical field and come out of position during manipulations for drainage. Subretinal fluid drainage may be performed in the bed of the future buckle at this time, if needed (see below subretinal fluid drainage section). Ideally, the buckle will support both the posterior-most aspect of the break and also the vitreous base. Two horizontal mattress sutures are placed in each quadrant.Ĭalipers should be used to mark the distance between the suture bites (or passes), such that the mark signifying the retinal break(s) is in the center. The suture passes are made parallel to the limbus for circumferential elements and tangential to the limbus for radial elements. For example, for a 516G grooved element, which is 6.4mm wide and 2.3mm high, the scleral passes may be placed approximately 8.5mm apart. Thus, the distance between the two scleral passes comprising the mattress suture must be greater than the size of the buckle – usually 2-3 mm wider than the buckle width. care should be taken to avoid torquing the needle such that the hub can poke into the sclera and cause a perforation.įor segmental buckle elements, in which height is attained by suture tightness and the length of the suture relative to the size of the buckle, imbrication is required to achieve height of the buckle. The pass should be performed slowly, and when removing the needle from the sclera, the curvature of the needle should be followed – i.e. ![]() A partial thickness (1/2 or 2/3 thickness) scleral pass should be made of approximately 4mm in length. The buckle should be moved out of the way if it has already been placed at the time of suture passes (e.g. Tenon’s capsule should have been cleanly dissected to reveal bare sclera as additional tissue on the scleral surface renders it difficult to gauge depth of the suture pass accurately. Safe suture pass technique: the field should be dry and largely free of blood. Figure 5: Horizontal mattress suture securing a 41 scleral buckle band, 5-0 Mersilene suture.
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