Relaxation of Encircling Buckle Improved Choroidal Blood Flow in a Patient with Visual Field Defect Following Encircling Procedure

Background We report a patient with a visual field defect after retinal reattachment by the encircling procedure for rhegmatogenous retinal detachment. We confirmed improved ocular blood flow after relaxation of the buckle. Case A 24-year-old woman with a visual field defect appearing after an encircling procedure for rhegmatogenous retinal detachment. Observations Before and after relaxing the encircling buckle, we measured tissue blood flow in the fundus of each eye of the patient using a Heidelberg retina flow meter. Preoperative measurements showed a reduction of blood flow at the disc rim in the diseased fundus, while retinal blood flow was not reduced (P = 0.026, disc rim area versus retinal area, one-factor analysis of variance, ANOVA). Indocyanine green angiography showed extensive peripheral filling delay. Electroretinography showed low a-wave and b-wave amplitudes, but normal oscillatory potential. The base value of the electro-oculogram was severely reduced in the right eye. The blood flow values after surgery indicated a significant improvement of blood flow (P = 0.01, one-factor ANOVA). No further progression in the visual field defect was observed, and visual acuity of the right eye improved from 0.8 to more than 1.0. Conclusions These results suggest that the choroidal circulation disturbance, which was found after the encircling procedure, had a plausible role in the development of the visual field defect.