Simulated Surgery: Retinal Buckling: Placing the Buckle

This video demonstrates how to cut the buckle to the correct length and then place it under the pre-placed sutures and then secure it in position by tying the sutures securely over the buckle.

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>> In this video, we show how the scleral buckle is placed under the preplaced sutures. The encircling buckle is cut to size, and it’s better to be generous with the amount of buckle that you have. You can always cut more off at the end. It should be remembered that you may want to place the buckle actually underneath the adjacent muscles. It’s much better to have it underneath the muscle, rather than halfway under and halfway out. A curved artery clip is placed under the sutures. And then, grasping the buckle, it can be gradually eased into position underneath the sutures. It’s always much easier to pull the buckle into position, rather than to push it in. Then the preplaced sutures are tightened, and the assistant is vital in this maneuver. The assistant should first of all try and push the buckle into the sclera, so create an indent, and then hold the knot. Push in and then grasp the knot. And then the surgeon can put another throw on the knot. It’s best to then hold the suture close to the knot, asking the assistant to hold on until you’re sure you’ve got the tension correct, and then the assistant can let go, and then a locking throw can be placed, to tighten the suture correctly. The suture is cut to length. And then the second suture can be tightened. Remembering that the idea of these sutures is actually to apply pressure to the buckle, to force it into the sclera, to create an internal indentation. Once again, the buckle is pushed inwards by the assistant. And then they close their forceps onto the knot. A needle holder is the best device for this. And the suture is then held close to the knot again. And the assistant releases, allowing the surgeon to put further throws on the knot, to lock it in place. The buckle should create a little ridge anteriorly, on the sclera. And when you see this anterior ridge, you can be assured that you’ve got a decent degree of indentation, internally. And the buckle is trimmed to size, so that it isn’t interfering with the muscles. And then its location can be checked with an indirect ophthalmoscope, to ensure that the buckle is in the correct position, in relation to the retinal break internally.

Last Updated: October 31, 2022

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