retinal surgery scleral buckling suture patterns mattress suture technique ophthalmology

retinal surgery sutures

scleral buckle horizontal mattress suture diagram retinal detachment surgery

https://eyewiki.org/Scleral_Buckling_for_Rhegmatogenous_Reti…

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mkdir -p "/tmp/workspace/retina-suture-patterns/src" "/tmp/workspace/retina-suture-patterns/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/retina-suture-patterns/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_LINE_DASH_STYLE from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE OUT='/tmp/workspace/retina-suture-patterns/output/Retinal_Surgery_Suture_Patterns.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(12,40,68); BLUE=RGBColor(30,107,162); TEAL=RGBColor(33,151,151); AQUA=RGBColor(221,243,245) ORANGE=RGBColor(239,139,63); RED=RGBColor(191,65,62); GOLD=RGBColor(235,184,63); INK=RGBColor(25,44,61); GREY=RGBColor(92,111,125); LIGHT=RGBColor(246,249,251); WHITE=RGBColor(255,255,255); PALE=RGBColor(234,241,246) def rect(sl,x,y,w,h,fill, line=None, radius=False): sh=sl.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill sh.line.color.rgb=line or fill return sh def txt(sl,x,y,w,h,text,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT, font='Aptos', valign=MSO_ANCHOR.TOP): tb=sl.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0; tf.vertical_anchor=valign for i,line in enumerate(text.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align; p.space_after=Pt(2) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def line(sl,x1,y1,x2,y2,color=INK,width=1.5,dash=None): c=sl.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); c.line.color.rgb=color; c.line.width=Pt(width) if dash: c.line.dash_style=dash return c def title(sl,number,heading,kicker='RETINAL DETACHMENT SURGERY'): rect(sl,0,0,13.333,.23,TEAL) txt(sl,.55,.42,1.1,.24,f'{number:02d}',11,TEAL,True) txt(sl,.55,.68,12.0,.52,heading,27,NAVY,True) txt(sl,.56,1.26,11.8,.25,kicker,9,GREY,True) line(sl,.55,1.6,12.78,1.6,RGBColor(210,222,229),.8) txt(sl,.55,7.12,10,.17,'Educational overview - techniques vary by surgeon, anatomy, and device.',8,GREY) txt(sl,12.25,7.10,.55,.18,str(number),8,GREY,True,PP_ALIGN.RIGHT) def bullet(sl,x,y,w,items,size=17, color=INK, accent=TEAL): yy=y for item in items: rect(sl,x,yy+.09,.11,.11,accent) txt(sl,x+.24,yy,w-.24,.52,item,size,color) yy+=.66 def eye_cross(sl,x,y,w,h): # simplified globe section sh=sl.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x), Inches(y), Inches(w), Inches(h)); sh.fill.solid(); sh.fill.fore_color.rgb=RGBColor(235,247,249); sh.line.color.rgb=NAVY; sh.line.width=Pt(2) sh=sl.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x+.18), Inches(y+.18), Inches(w-.36), Inches(h-.36)); sh.fill.background(); sh.line.color.rgb=TEAL; sh.line.width=Pt(1.5) # retina arc schematic sl.shapes.add_shape(MSO_SHAPE.ARC, Inches(x+.52), Inches(y+.52), Inches(w-1.04), Inches(h-1.04)).line.color.rgb=ORANGE arc=sl.shapes[-1]; arc.line.width=Pt(3) # break and buckle support rect(sl,x+w-.36,y+h*.47,.23,.48,RED,RED,True) rect(sl,x+w-.05,y+h*.35,.24,.74,BLUE,BLUE,True) txt(sl,x+w*.37,y+h*.40,1,.25,'vitreous',10,GREY) def mattress(sl,x,y,w=3.2,h=2.0): # scleral bed and explant rect(sl,x,y+h*.58,w,.28,RGBColor(246,222,201),ORANGE,True) rect(sl,x+.45,y+h*.88,w-.9,.35,RGBColor(159,198,220),BLUE,True) # horizontal U limbs line(sl,x+.5,y+h*.50,x+.76,y+h*.20,NAVY,2) line(sl,x+.76,y+h*.20,x+w-.76,y+h*.20,NAVY,2) line(sl,x+w-.76,y+h*.20,x+w-.5,y+h*.50,NAVY,2) # needle passes line(sl,x+.5,y+h*.5,x+.65,y+h*.75,NAVY,2) line(sl,x+w-.5,y+h*.5,x+w-.65,y+h*.75,NAVY,2) txt(sl,x+.68,y+h*.02,w-1.36,.18,'horizontal mattress',11,NAVY,True,PP_ALIGN.CENTER) def add_notes(sl, note): ns=sl.notes_slide ns.notes_text_frame.text = note # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,.18,TEAL) txt(s,.7,.72,5.7,.28,'OPHTHALMIC SURGERY | PRACTICAL REVIEW',11,RGBColor(134,220,216),True) txt(s,.7,1.22,7.2,1.35,'Suture Patterns\nin Retinal Surgery',35,WHITE,True) txt(s,.73,2.88,6.3,.55,'Primary focus: scleral buckling for rhegmatogenous retinal detachment',18,RGBColor(215,232,241)) rect(s,.72,4.05,5.75,1.18,RGBColor(19,63,97),RGBColor(19,63,97),True) txt(s,1.0,4.32,5.2,.5,'Recognize the pattern. Understand its purpose. Avoid perforation.',16,WHITE,True,PP_ALIGN.CENTER) eye_cross(s,8.5,1.18,3.65,3.65) # subtle path line(s,8.52,5.36,11.88,5.36,RGBColor(62,108,141),1.2) txt(s,8.5,5.6,3.7,.55,'For teaching and supervised surgical training only.',13,RGBColor(189,210,224),False,PP_ALIGN.CENTER) add_notes(s,'Overview deck. The term suture patterns in retinal surgery is broad; this presentation emphasizes extraocular suturing in scleral buckling and distinguishes it from PPV wound closure.') # 2 s=prs.slides.add_slide(blank); title(s,2,'Where do sutures matter?') for x,hd,body,c in [(0.65,'Scleral buckling','Fixation of silicone explant\nSupport of encircling band\nExtraocular muscle control',BLUE),(4.72,'Pars plana vitrectomy','Usually transconjunctival and\nsutureless in small-gauge systems\nSuture if wound leaks',TEAL),(8.79,'Conjunctival closure','Interrupted or running closure\nafter external retinal surgery\nTissue handling matters',ORANGE)]: rect(s,x,2.0,3.55,3.65,WHITE,RGBColor(210,222,229),True); rect(s,x,2.0,3.55,.12,c) txt(s,x+.25,2.35,3.05,.35,hd,20,NAVY,True) txt(s,x+.25,3.0,3.0,1.2,body,16,INK) rect(s,x+.25,4.75,2.9,.42,PALE,PALE,True); txt(s,x+.38,4.87,2.65,.16,'This deck emphasizes scleral buckle fixation',9,GREY,False,PP_ALIGN.CENTER) txt(s,.68,6.15,11.6,.48,'Key idea: the “retina” is not directly sutured in standard scleral buckling. The silicone explant is secured to sclera to create an external indentation.',18,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'Explain the scope. Standard small-gauge PPV is commonly sutureless; when necessary, leaking sclerotomies or conjunctiva can be closed. The teaching focus is scleral-buckle suture configuration.') # 3 s=prs.slides.add_slide(blank); title(s,3,'Scleral buckle: the mechanical goal') eye_cross(s,.75,2.0,4.0,4.0) txt(s,1.13,5.72,3.25,.32,'External explant creates an inward buckle',12,NAVY,True,PP_ALIGN.CENTER) # process for i,(hd,bd,c) in enumerate([('1. Localize','Retinal break and\nvitreous base',TEAL),('2. Retinopexy','Cryotherapy or laser\ncreates adhesion',ORANGE),('3. Secure explant','Suture geometry\nsets indentation',BLUE),('4. Verify','Break supported;\nperfusion preserved',RED)]): x=5.35+i*1.82; rect(s,x,2.55,1.5,2.18,WHITE,RGBColor(204,217,226),True); rect(s,x,2.55,1.5,.12,c); txt(s,x+.14,2.9,1.22,.35,hd,14,NAVY,True,PP_ALIGN.CENTER); txt(s,x+.12,3.55,1.26,.64,bd,12,INK,False,PP_ALIGN.CENTER) if i<3: line(s,x+1.5,3.65,x+1.8,3.65,GREY,1.5) txt(s,5.35,5.35,6.95,.68,'A correctly placed buckle supports the break and reduces dynamic vitreoretinal traction. Buckle configuration may be radial, segmental, circumferential, or encircling.',16,INK) add_notes(s,'Kanski: explant sutured to sclera creates inward indentation; intended to close breaks by opposing RPE to sensory retina and reducing dynamic traction. The entire break ideally has approximately 2 mm coverage.') #4 s=prs.slides.add_slide(blank); title(s,4,'Pattern 1: traction (bridle) suture') rect(s,.7,2.0,5.3,4.38,WHITE,RGBColor(210,222,229),True) # rectus muscle strap and suture loop rect(s,1.35,3.25,3.8,.52,RGBColor(221,183,157),RGBColor(178,123,90),True); txt(s,2.18,3.41,2.1,.15,'RECTUS MUSCLE',10,INK,True,PP_ALIGN.CENTER) line(s,1.78,2.65,1.48,3.20,TEAL,3); line(s,1.48,3.20,1.78,4.37,TEAL,3); line(s,1.78,4.37,2.2,4.7,TEAL,3) line(s,4.65,2.65,4.95,3.20,TEAL,3); line(s,4.95,3.20,4.65,4.37,TEAL,3); line(s,4.65,4.37,4.25,4.7,TEAL,3) txt(s,1.45,5.12,4.25,.5,'Loop under muscle for globe control\nand exposure.',15,NAVY,True,PP_ALIGN.CENTER) rect(s,6.55,2.05,5.9,4.3,PALE,PALE,True) txt(s,6.9,2.37,5.1,.35,'Purpose and cautions',21,NAVY,True) bullet(s,6.9,2.96,5.1,['Temporary traction to rotate and stabilize the globe.','Placed after isolating the extraocular muscle with a hook.','Avoid splitting or traumatizing muscle and avoid scleral perforation.','This is an exposure suture, not a buckle-fixation pattern.'],16) add_notes(s,'StatPearls describes bridle sutures for all four recti, commonly braided 2-0 silk. Stress: traction suture supports exposure rather than explant fixation.') #5 s=prs.slides.add_slide(blank); title(s,5,'Pattern 2: horizontal mattress fixation') mattress(s,.85,2.0,4.8,2.8) txt(s,.95,5.1,4.55,.53,'The workhorse pattern for segmental silicone explants.',18,NAVY,True,PP_ALIGN.CENTER) rect(s,6.1,1.95,6.2,4.92,WHITE,RGBColor(210,222,229),True) txt(s,6.45,2.25,5.5,.35,'Technical principles',21,NAVY,True) bullet(s,6.45,2.88,5.45,['Sutures are typically nonabsorbable synthetic material, often 5-0 nylon, on spatulated cutting needles.','Passes are intrascleral and parallel to the long axis of the explant.','For broad explants/sponges, long bites are preferred. Intersuture distance and tension determine indentation.','Keep needle tip visible throughout its course; avoid full-thickness passage.'],15) rect(s,6.45,5.92,5.48,.47,RGBColor(255,241,221),RGBColor(255,241,221),True); txt(s,6.62,6.07,5.12,.15,'Horizontal mattress distributes force and anchors the explant.',10,RGBColor(138,76,21),True,PP_ALIGN.CENTER) add_notes(s,'EyeWiki: segmental silicone explants secured with 5-0 nonabsorbable synthetic sutures in horizontal mattress. One-half to two-thirds thickness intrascleral passes, at least 6 mm long, for sponges/broad explants. StatPearls: 4-5 mm intrascleral length, square configuration, about half thickness, parallel sutures yield greater indentation.') #6 s=prs.slides.add_slide(blank); title(s,6,'Pattern geometry changes the buckle') configs=[('Radial','Supports a single\nsmall break',[(1.75,3.6,2.28,3.6)],ORANGE),('Segmental','Broad, localized\nsupport',[(5.15,3.1,5.15,4.05)],BLUE),('Circumferential','Follows globe\ncontour',[(8.05,3.05,9.42,3.05)],TEAL),('Encircling','360° band for\ndiffuse support',[(11.35,3.1,11.35,4.1)],RED)] for i,(hd,bd,_,c) in enumerate(configs): x=.72+i*3.1; rect(s,x,2.0,2.68,3.94,WHITE,RGBColor(210,222,229),True); txt(s,x+.18,2.27,2.3,.29,hd,18,NAVY,True,PP_ALIGN.CENTER) # globe sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x+.65),Inches(3.0),Inches(1.38),Inches(1.38)); sh.fill.solid(); sh.fill.fore_color.rgb=RGBColor(235,247,249); sh.line.color.rgb=NAVY if i==0: line(s,x+1.34,2.86,x+1.34,4.5,c,5) if i==1: line(s,x+.42,3.68,x+2.25,3.68,c,5) if i==2: arc=s.shapes.add_shape(MSO_SHAPE.ARC,Inches(x+.46),Inches(2.82),Inches(1.8),Inches(1.8)); arc.line.color.rgb=c; arc.line.width=Pt(4) if i==3: sh2=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x+.52),Inches(2.87),Inches(1.64),Inches(1.64)); sh2.fill.background(); sh2.line.color.rgb=c; sh2.line.width=Pt(4) txt(s,x+.22,4.85,2.22,.5,bd,13,INK,False,PP_ALIGN.CENTER) txt(s,.75,6.28,11.7,.45,'The same mattress principle may be used with different explant configurations. Pattern choice follows break size, location, number, and vitreous-base pathology.',16,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'Kanski states buckle configuration can be radial, segmental, circumferential or encircling depending on the size, configuration and number of breaks.') #7 s=prs.slides.add_slide(blank); title(s,7,'Encircling band: sutures or scleral tunnels?') rect(s,.72,1.95,5.84,4.92,WHITE,RGBColor(210,222,229),True); txt(s,1.02,2.25,5.1,.35,'Suture-supported band',21,NAVY,True) # band and two mattress symbols sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(2.5),Inches(3.0),Inches(2.1),Inches(2.1)); sh.fill.background(); sh.line.color.rgb=TEAL; sh.line.width=Pt(6) for xx in [1.5,4.9]: mattress(s,xx,3.05,1.0,.9) txt(s,1.05,5.62,5.15,.6,'Shorter intrascleral passes can support an encircling band. Temporary tying allows indentation to be adjusted.',15,INK,False,PP_ALIGN.CENTER) rect(s,6.78,1.95,5.84,4.92,PALE,PALE,True); txt(s,7.08,2.25,5.1,.35,'Belt-loop (scleral tunnel) option',21,NAVY,True) # globe band and loops sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(8.65),Inches(3.0),Inches(2.1),Inches(2.1)); sh.fill.background(); sh.line.color.rgb=ORANGE; sh.line.width=Pt(6) for xx in [8.27,10.7]: rect(s,xx,3.72,.42,.24,WHITE,ORANGE,True) txt(s,7.1,5.62,5.1,.6,'A band may be passed beneath scleral tunnels, avoiding fixation sutures at each point. Device and surgeon preference govern selection.',15,INK,False,PP_ALIGN.CENTER) add_notes(s,'EyeWiki describes mattress sutures for broad encircling buckle. Contemporary techniques may use belt loops/scleral tunnels. This is a comparison schematic, not a procedural instruction.') #8 s=prs.slides.add_slide(blank); title(s,8,'Safety checkpoints: prevent the avoidable complication') items=[('Depth','Aim for partial-thickness intrascleral passes. Full-thickness penetration risks retinal injury and hemorrhage.',RED),('Needle control','Keep the tip visible; use focal counterpressure to prevent scleral buckling ahead of the needle.',ORANGE),('Geometry','Keep bites symmetric and parallel. Irregular/nonparallel sutures yield less predictable indentation.',TEAL),('Tension & perfusion','Tighten progressively, reassess buckle height and confirm retinal/central artery perfusion when indicated.',BLUE)] for i,(hd,bd,c) in enumerate(items): x=.72+(i%2)*6.1; y=1.95+(i//2)*2.35 rect(s,x,y,5.72,1.85,WHITE,RGBColor(210,222,229),True); rect(s,x,y,.14,1.85,c); txt(s,x+.36,y+.28,4.9,.28,hd,19,NAVY,True); txt(s,x+.36,y+.76,4.92,.75,bd,15,INK) rect(s,.72,6.58,11.9,.34,RGBColor(255,240,238),RGBColor(255,240,238),True); txt(s,.9,6.68,11.55,.12,'Warning signs during passage may include subretinal fluid, blood, or pigment at the scleral surface. Escalate to the operating surgeon.',10,RED,True,PP_ALIGN.CENTER) add_notes(s,'EyeWiki and StatPearls: inadvertent scleral perforation can cause SRF drainage, retinal break, vitreous loss, subretinal/subchoroidal hemorrhage and hypotony. Warning signs include SRF, blood or pigment. This slide highlights supervised practice and escalation.') #9 s=prs.slides.add_slide(blank); title(s,9,'Take-home summary') for i,(num,head,body,c) in enumerate([('01','Name the pattern','Bridle suture controls the globe. Horizontal mattress secures the explant.',TEAL),('02','Respect geometry','Partial-thickness, symmetric, parallel intrascleral bites produce a predictable buckle.',BLUE),('03','Match pattern to purpose','Use explant configuration and fixation strategy that supports the break and vitreous base.',ORANGE),('04','Safety before speed','Visualize needle position, avoid full-thickness passage, and reassess tension/perfusion.',RED)]): y=1.93+i*1.05; rect(s,.8,y,11.72,.78,WHITE,RGBColor(212,224,231),True); rect(s,.8,y,.84,.78,c,c,True); txt(s,.94,y+.22,.5,.22,num,15,WHITE,True,PP_ALIGN.CENTER); txt(s,1.94,y+.17,2.55,.25,head,16,NAVY,True); txt(s,4.5,y+.17,7.55,.31,body,14,INK) txt(s,.8,6.36,11.7,.2,'Selected sources',11,NAVY,True) txt(s,.8,6.61,11.8,.34,'Kanski’s Clinical Ophthalmology, 10th ed., “Principles of scleral buckling.” | EyeWiki: Scleral Buckling for Rhegmatogenous Retinal Detachment. | StatPearls: Scleral Buckling (NBK580486).',9,GREY) add_notes(s,'Sources used: Kanski’s Clinical Ophthalmology A Systematic Approach, 10th ed., Principles of scleral buckling; EyeWiki, Scleral Buckling for Rhegmatogenous Retinal Detachment; StatPearls, Scleral Buckling. Content current as educational summary, not a surgical protocol.') prs.core_properties.title='Suture Patterns in Retinal Surgery' prs.core_properties.subject='Educational overview of scleral buckle suture patterns' prs.core_properties.author='Orris' prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/retina-suture-patterns/src/create_deck.py" ls -lh "/tmp/workspace/retina-suture-patterns/output/Retinal_Surgery_Suture_Patterns.pptx"

python - <<'PY' from pptx import Presentation p='/tmp/workspace/retina-suture-patterns/output/Retinal_Surgery_Suture_Patterns.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text.strip(): texts.append(sh.text.replace('\n',' | ')) print(i, ' | '.join(texts[:4])) print('size', prs.slide_width, prs.slide_height) PY