Electroretinogram changes after scleral buckling surgery of retinal detachment

Objective To observe changes in visual function after a single scleral buckling surgery for rhegmatogenous retinal detachment (RD) by using ERG (electroretinogram). Methods One eye from 56 patients with rhegmatogenous RD was chosen. Forty-three corresponding normal fellow eyes from these patients were chosen as controls. Single scleral buckling surgery was carried out and a full-field ERG was performed before the surgery, and 1 and 6 months after surgery. Results The mean amplitude of ERG decreased and the latency (except for the a-wave) was delayed in the eye with a retinal detachment, and wavelets of the oscillatory potential decreased or were completely lacking. One month after surgery, the amplitudes of the a and b waves were noticeably improved (except for the 30 Hz flicker responses), but the latency (except for the a-wave) was still delayed. The ratio of b/a (mixed response) increased 1 month after surgery, with no further changes thereafter. The amplitude of the scotopic b wave was 58.1% of the control eyes, while the 30 Hz flicker responses was only 45.8% of controls; the difference between the two responses was significant (P < 0.001). The number of oscillatory potential wavelets increased, but the total amplitude of the oscillatory potentials did not exhibit any obvious changes during the follow-up period (P = 0.20). In the 41 patients whose detachment involved the macula preoperatively, the amplitude of the 30 Hz flicker responses improved significantly after surgery (P = 0.037). Six months after the operation, the wave amplitudes were not significantly different from 1 month after surgery, but there was a tendency toward a decrease in the latency. Conclusions After reattachment of the retina, visual function showed dramatic improvement 1 month after the surgery. The postreceptoral responses recovered more than the a-wave. The rod system recovered more quickly and completely than the cone system during the follow-up period. The incomplete recovery observed by using ERGs indicates that there is irreversible damage that likely occurs following retinal detachment and surgery.     

Optical coherence tomography of the neurosensory retina in rhegmatogenous retinal detachment

PURPOSE: To clarify the pathologic changes of the detached neurosensory retina in rhegmatogenous retinal detachment. METHODS: Retinal images were prospectively examined by optical coherence tomography in 25 eyes of 25 consecutive patients with rhegmatogenous retinal detachment. We excluded the patients whose retinal detachment did not involve the central fovea or patients with poor fixation during optical coherence tomography (OCT) examination. Optical coherence tomography was scanned through the center of the fovea. The patients ranged in age from 15 to 77 years (mean, 45 years; SD, 20 years). The period from onset of subjective symptoms of retinal detachment to OCT ranged from 2 to 60 days (mean, 16 days; SD, 18 days). Optical coherence tomography findings, best-corrected visual acuity, and the height of the retinal detachment at the central fovea were statistically analyzed using ANCOVA (analysis of covariance) and the Mann-Whitney U test. RESULTS: In 25 eyes of 25 patients, OCT of the detached neurosensory retina at and adjacent to the center of the fovea demonstrated normal retinal structure (10 eyes, 40%), intraretinal separation (7 eyes, 28%), and an undulated separated outer retina (8 eyes, 32%). Three statistically significant factors affected best-corrected visual acuity: intraretinal separation (P = .001), intraretinal separation with undulated outer retina (P = .001), and height of retinal detachment at the central fovea (P<.001). Best-corrected visual acuity was significantly worse in the 15 eyes with intraretinal separation with or without an undulated outer retina than in the 10 eyes with retinal thickening but no intraretinal separation (P = .036). The eight eyes with undulated separated outer retina showed significantly higher retinal detachment at the central fovea than the seven eyes with intraretinal separation but no undulated outer retina (P = .009) and the 10 eyes without intraretinal separation (P = .016). The duration from onset of subjective symptoms to OCT was not related to the occurrence of intraretinal separation of the detached retina. CONCLUSIONS: Intraretinal separation of the detached retina occurred frequently and shortly after retinal detachment in rhegmatogenous retinal detachment and was one of the factors associated with poor vision in rhegmatogenous retinal detachment. Best-corrected visual acuity significantly decreased in the highly detached retina.     

Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively

PURPOSE: To present the postoperative optical coherence tomography (OCT) findings of the macula in rhegmatogenous retinal detachment with spared macula preoperatively. METHODS: Eleven of 46 patients who underwent surgery for rhegmatogenous retinal detachment had an uninvolved macula preoperatively. Scleral buckling without intravitreous gas injection was the operation used in all eyes. All 11 patients were examined before and after treatment with slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and OCT. RESULTS: In 3 of the 11 patients with rhegmatogenous retinal detachment and uninvolved macula preoperatively, fluid was identified with OCT in the macula after successful treatment. OCT showed that the fluid gradually diminished and finally disappeared 5 to 7 months after the scleral buckling procedure. The fluid in the macula became visible with slit-lamp biomicroscopy in only one of the three patients. CONCLUSION: Subretinal fluid in a preoperatively uninvolved macula can be found after successful treatment of rhegmatogenous retinal detachment. If the fluid is located in the fovea, the visual acuity decreases and does not reach the preoperative levels. OCT identifies the presence of fluid and contributes to the study of the fluid's evolution.     

影响视网膜脱离患者视网膜功能的因素

目的:评价视网膜脱离患者年龄、病程、视网膜脱离面积、黄斑脱离情况等因素对视网膜功能的影响。方法:将孔源性视网膜脱离(retinal detachment,RD)188例189眼的患者年龄、病程、视网膜脱离面积、黄斑脱离情况、视力与视网膜脱离眼的fERG和mfERG各指标进行相关分析。结果:影响RD眼fERG和mfERG的主要因素是脱离面积、黄斑脱离和视力。以|γ|>0.4,且P≤0.05判定为有相关性。脱离面积与明视和暗适应最大反应ERG a、b波幅值,30Hz闪烁光幅值,OPs波数和幅值负相关;与mfERG象限野P1波幅值密度、幅值负相关。相关系数最高者为fERG暗适应最大反应b波幅值(γ=-0.704)。黄斑脱离与明视和暗适应最大反应ERG b波幅值,30Hz闪烁光ERG幅值负相关;与mfERG环形野环1的P1波幅值密度、幅值负相关,与mfERG象限野P1波幅值密度负相关,相关系数最高者为mfERG环形野环1的P1波幅值(γ=-0.584)。视力与明视和暗适应最大反应a、b波幅值,30Hz闪烁光幅值,OPs子波数和幅值正相关;与mfERG环形野环1的P1波幅值密度、幅值正相关,相关系数最高者为30Hz闪烁光ERG幅值(γ=0.597)。RD眼的fERG异常率最高者为暗适应最大反应ERG b波幅值,异常率为71.3%,视网膜脱离象限野mfERG异常率最高者为P1波幅值,异常率为85.3%。结论:影响RD患者视网膜功能的重要因素是脱离面积和黄斑脱离情况。RD眼对视网膜功能异常反应的mfERG对视网膜功能异常反应的敏感性高于fERG。     

Persistent foveal retinal detachment after successful rhegmatogenous retinal detachment surgery

PURPOSE: To describe the tomographic features of the neurosensory retina after successful rhegmatogenous retinal detachment surgery. DESIGN: Cohort study. METHODS: We prospectively examined cross-sectional retinal images using optical coherence tomography (OCT) in 15 eyes of 15 consecutive patients (mean age, 46 years) who underwent scleral buckling surgery for treatment of rhegmatogenous retinal detachment. The retinas appeared reattached upon binocular stereoscopic indirect ophthalmoscopy. All eyes were examined at 1, 3, 6, and 12 months postoperatively. The time from onset of subjective symptoms of retinal detachment to retinal surgery ranged from 4 to 66 days (mean, 14 days). The postoperative OCT findings and best-corrected visual acuity were statistically analyzed using the Mann-Whitney U test. RESULTS: The detached retinas appeared attached on ophthalmoscopy in all eyes 1 month postoperatively. OCT showed residual retinal detachment in four eyes (27%) at the fovea and in three eyes (20%) at the fovea and adjacent area. The remaining eight retinas (53%) were attached when examined tomographically. In six of the seven eyes with residual foveal detachment by OCT, the retinas reattached spontaneously up to 12 months postoperatively. The postoperative best-corrected visual acuity improved gradually during 12 postoperative months in all 15 eyes. A substantial increase in visual acuity occurred when the fovea reattached in the six eyes with residual detachment. CONCLUSIONS: Foveal retinal detachment may persist after successful retinal detachment surgery in eyes in which the fovea appeared to be attached on ophthalmoscopy. The residual foveal detachment may explain, in part, the delayed visual acuity improvement after successful scleral buckling.     

Predictive visual outcome after macula-off retinal detachment surgery using optical coherence tomography

PURPOSE: To determine whether preoperative optical coherence tomography (OCT) is useful in predicting postoperative visual outcome for patients with primary macula-off rhegmatogenous retinal detachment (RD). METHODS: This prospective study included 20 nonconsecutive eyes with macula-off RD and successful reattachment of the retina. Preoperative 5-mm OCT was performed through the center of the fovea. The relationship among preoperative OCT findings, main preoperative clinical variables, and final postoperative visual acuity was statistically analyzed. RESULTS: Final postoperative visual acuity was negatively correlated with three preoperative OCT variables: height of RD at the central fovea (r=0.79; P <0.001), distance from the central fovea to the nearest undetached retina (r=0.75; P <0.00051), and, to a lesser degree, extent of structural changes in the detached retina (r=0.48; P=0.03). Preoperative visual acuity was the only clinical variable statistically correlated with final postoperative visual acuity in this study (r=0.55; P=0.01). Using multivariate logistic regression analyses, the structure of the detached retina combined with the distance from the central fovea to the nearest undetached retina, as determined with OCT, was highly correlated with final postoperative visual acuity (r=0.82; P <0.000051). CONCLUSION: Preoperative macular analysis with OCT may help to predict visual outcome for patients with macula-off RD.     

Retinal thickening after successful surgery for macula-off retinal detachment

PURPOSE: To study changes in retinal thickness after reattachment of the retina after scleral buckling surgery for rhegmatogenous retinal detachment. METHODS: In this retrospective study, patients were classified into three subgroups according to preoperative macular status. Retinal thickness within 3 mm of the center was measured with optical coherence tomography. RESULTS: Foveal retinal thickness at a mean of 2 years postoperatively was significantly increased in patients with preoperatively detached macula. Additionally retinal thickness in the fovea and postoperative visual acuity was positively correlated. CONCLUSIONS: Successful surgery for macula-off retinal detachment is associated with significant thickening of the neurosensory retina when examined with optical coherence tomography 6 months postoperatively.     

25G内定位联合微创巩膜外加压治疗孔源性视网膜脱离

目的：观察Resight非接触广角镜辅助下25G光纤内照明联合微创巩膜外加压治疗孔源性视网膜脱离的临床效果。

方法：回顾性分析2011-05/2015-03入院的视网膜脱离患者43例43眼,术前散瞳后前置镜、三面镜检查裂孔定位不明确,术中25G套管穿刺光纤内照明,Resight非接触广角镜下顶压查找裂孔,进行微创巩膜外加压。对所有患者在手术后第1wk,1、3、6mo各随访1次,采用手术前相同的设备和方法记录视力、眼压,观察视网膜复位和裂孔封闭情况。

结果：所有患者中,41例41眼一次性复位,复位率为95.3%。1例1眼患者视网膜未完全复位,视网膜下积液残留,加压嵴位置欠佳,再次巩膜外加压手术复位; 1例1眼发生增殖性玻璃体视网膜病变(PVR)形成裂孔,采取玻璃体视网膜手术后完全复位。

结论：对于术前检查裂孔不明确的视网膜脱离患者,采用25G内定位联合微创巩膜外加压术可以做到微创、定位准确,并可提高手术成功率。     

Optical coherence tomography evaluation of detached macula from rhegmatogenous retinal detachment and central serous chorioretinopathy

PURPOSE: To compare structural changes using optical coherence tomography (OCT) and visual acuity (VA) loss in patients with shallow macula-off rhegmatogenous retinal detachment (RD) and central serous chorioretinopathy (CSC) involving the macula. DESIGN: Retrospective, comparative observational study. METHODS: Fifteen eyes with rhegmatogenous RD and 21 eyes with CSC with comparable height of macular detachment (< or = 550 microm) were evaluated retrospectively. All eyes were subjected to complete ophthalmologic examination, including OCT analysis, and were followed up until complete resolution of RD. RESULTS: The mean height +/- standard deviation at the fovea was 290 +/- 153 microm in rhegmatogenous RD and 310 +/- 141 microm in CSC. Although the duration of symptoms was longer in CSC than in rhegmatogenous RD (35.0 +/- 38.0 days vs 8.3 +/- 8.0 days), initial (0.25 vs 0.64 logarithm of the minimum angle of resolution [logMAR] units; P = .001) and final VA (0.09 vs 0.49 logMAR units; P < .001) were significantly better in CSC. OCT analysis of rhegmatogenous RD showed intraretinal cyst formation, intraretinal separation, and undulation of outer detached retina in 10 (67%), nine (60%), and six (40%) eyes, respectively. Eyes with two or more preoperative structural changes had poorer initial VA than eyes with none or one structural change. In comparison, none of the 21 CSC eyes showed any of these changes (P < .001). CONCLUSIONS: Compared with CSC, macula-involving rhegmatogenous RD resulted in more rapid visual loss, despite similar height of foveal detachment. Structural changes on OCT may be correlated with different levels of visual function in these two conditions.     

频域光相干断层扫描视网膜脱离术后黄斑改变

目的 分析累及黄斑区的孔源性视网膜脱离巩膜外垫压术后黄斑区形态改变。方法 累及黄斑的孔源性视网膜脱离43例,经间接检眼镜下巩膜扣带术和（或）联合环扎术后,视网膜解剖复位。分别于术后1周、1月、3月、6月复查视力、眼底检查和频域OCT检查并统计分析。结果 术后1周时,最佳矫正视力0．05～0．3,较术前提高（P=0．015）;OCT显示黄斑区视网膜下液完全吸收者占11．6％,好转者占44．2％,与术前相比差异有统计学意义（P：0．008）。术后3个月时,最佳矫正视力0．3～0．6,提高2行以上者占76．7％。术后12个月最佳矫正视力0．3—1．0,提高2行以上者占93．0％,与术后3个月时相比差异有统计学意义（P=0．025）,与术后6个月时相比差异无统计学意义（P=0．24）,黄斑区视网膜下液完全吸收者占90．7％,与术后6个月时相比差异有统计学意义（P=0．0018）。结论 频域OCT检查能够发现临床眼底检查不能发现的黄斑区神经上皮脱离的存在,黄斑区视网膜光感受器内外节连接结构连续性中断,进而为预测累及黄斑区的孔源性视网膜脱离术后视力恢复进程及病情解释提供依据。     

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment

Purpose:To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).Design:Retrospective interventional case series.Results:Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.Conclusion:Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.     

Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment

Trans pars plana vitrectomy with air-fluid exchange was performed on 29 selected cases of primary rhegmatogenous retinal detachment in which scleral buckling would be the usual surgical approach. The group contained 20 phakic eyes, two aphakic eyes, and seven pseudophakic eyes; the macula was detached preoperatively in 17 eyes (66%). The reattachment rate after one operation was 79% (23 of 29 eyes); after two operations this increased to 93% (27 of 29 eyes). Visual acuities of 20/50 or better were achieved in 22 of 27 successfully treated cases (81%). Vitrectomy without scleral buckling may allow retinal reattachment with excellent visual results in selected cases of primary rhegmatogenous retinal detachment.     

Postoperative laser coagulation as retinopexy in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery: a prospective clinical study

PURPOSE: To evaluate postoperative laser photocoagulation as retinopexy mode in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery. METHODS: The authors conducted a prospective feasibility study of consecutive patients with rhegmatogenous retinal detachment treated with scleral buckling surgery and postoperative laser during an 18-month period with a minimal follow-up of 6 months. Outcome measures were total retinal reattachment and the occurrence of proliferative vitreoretinopathy (PVR). RESULTS: A total of 123 patients (124 eyes) were included in this study. Seventy-six percent were phakic and 24% were pseudophakic. Fifty percent presented with one horseshoe tear, 15% with multiple tears, 30% with round breaks, and 5% with no identifiable break. Ten percent presented with a vitreous hemorrhage and 25% with three or four quadrants of detached retina. Six patients had PVR C1. Twelve patients required a postoperative gas injection, five patients received an additional buckle, and five patients underwent a vitrectomy, in four because of PVR. In all patients the retina was fully reattached at the end of follow-up. Planned postoperative laser coagulation took place 1 day to 10 weeks (median 3(1/2) weeks) after buckling surgery. Buckling material was removed in three patients without redetachment. CONCLUSION: Postoperative laser coagulation is a feasible alternative retinopexy mode in scleral buckling surgery, with encouraging anatomical results and a low incidence of PVR.     

多焦视网膜电图及彩色多普勒在视网膜脱离术患者中的应用

目的：通过对视网膜脱离患者术前、术后的血流动力学研究及视网膜功能的了解,判断视网膜脱离患者的术后恢复情况,并探讨两种检测方法的临床价值。 方法：对我院62例孔源性视网膜脱离患者,通过彩色多普勒（CDI）检测视网膜中央动脉（CRA）的收缩期峰值流速（Vmax）、舒张末期流速（Vmin）、阻力指数（RI）;多焦视网膜电图（mfERG）分别对视网膜脱离患者的术前、术后进行检测,并以对侧正常眼作对照组。 结果：CDI术前患眼与对照眼的CRA各项指标比较,差异无统计学意义。术后2wk视网膜脱离眼CRA的Vmax,Vmin均较术前降低,RI增高,差异有统计学意义（P<0.05）。视网膜脱离术后患者脱离区mfERG的a波、b波振幅密度均明显高于术前,潜伏期比手术前明显缩短,有统计学意义（P<0.05）。 结论：通过mfERG,CDI的联合检测能及时了解视网膜脱离术后的视网膜复位情况及硅胶海绵垫压后CRA的血流情况,从而避免视网膜脱离术后视网膜部分复位不良,巩膜因缺血引起局部坏死等情况发生。     

Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment

AIMS: This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV). METHODS: Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months. RESULTS: Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 (n=22), postoperative OCT showed persistent foveal detachment in 63% of cases (n=14) at 1 and 3 months. At 6 and 12 months, 36% (n=8) and 9% (n=2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 (n=21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1-3 months. No foveal abnormality was seen at 6 and 12 months postoperatively. CONCLUSIONS: A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.     

巩膜扣带术联合氩激光光凝治疗视网膜脱离

目的 探讨将巩膜扣带术中冷凝改为术后氩激光光凝封闭裂孔,治疗视网膜脱离（retinal detachment,RD)的疗效及适应证范围。方法 回顾性分析1999年12月至2000年4月,在我院行巩膜扣带术接受氩激光光凝治疗的RD患者35例（38只眼）的临床资料。结果 术后随访3－6个月,38只眼中,视网膜完全复位36只眼（94．7％）。术后视力≥0。05者31只眼（86．1％）,最佳矫正视力为1．0。结论 将巩膜扣带术中冷凝改为术后氩激光光凝,可简化术中操作,减少视网膜和脉络膜血管的损伤及术后并发症的发生,是治疗RD的有效方法之一。     

巩膜扣带术与玻璃体切割术治疗累及黄斑的孔源性视网膜脱离后对黄斑结构改变及视力预后的影响

背景 视网膜脱离患者在成功完成视网膜复位手术后并不能很快恢复视力,其原因目前尚不十分清楚. 目的 比较累及黄斑的孔源性视网膜脱离患者巩膜扣带术和玻璃体切割术后黄斑椭圆体区完整性、黄斑区视网膜神经上皮层下积液的发生率及留存时间,探讨黄斑区视网膜神经上皮层下积液存留对视力预后的影响.方法 回顾性分析2010年1月至2013年1月于北京大学人民医院眼科确诊的孔源性视网膜脱离患者66例66眼的病例资料,按手术方式分为巩膜扣带术组和玻璃体切割术组,记录2个组患者病程、屈光状态、最佳矫正视力LogMAR、有无合并症等,观察黄斑区神经上皮下积液存留时间及黄斑椭圆体区完整性,计算2个组在术后1个月时黄斑区神经上皮下积液的发生率. 结果 术前巩膜扣带术组及玻璃体切割术组间年龄、性别、病程、屈光度及LogMAR视力差异均无统计学意义(均P＞0.05).巩膜扣带术组视网膜下积液平均存留(96±60)d,玻璃体切割术组为(21±6)d,差异有统计学意义(t=7.966,P=0.000).术后1个月时,巩膜扣带术组黄斑区神经上皮下积液发生率为78.6％,大于玻璃体切割术组的12.5％,差异有统计学意义(x2=26.891,P=0.000),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异有统计学意义(t=3.185,P=0.003);术后6个月时,巩膜扣带术组与玻璃体切割术组LogMAR视力比较,差异无统计学意义(t=1.876,P--0.065),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异无统计学意义(t=1.755,P=0.087).视网膜神经上皮下积液吸收后,2个组内黄斑椭圆体区连续患者与椭圆体区缺失患者LogMAR视力比较,差异均有统计学意义(巩膜扣带术组:t=2.555,P=0.015;玻璃体切割术组:t=4.005,P=0.001). 结论 椭圆体区受损程度与视网膜脱离时间有关,而椭圆体区的完整性明显影响患者的视力预后.对于累及黄斑的孔源性视网膜脱离患者,玻璃体切割术后视网膜神经上皮下积液吸收较巩膜扣带术快;视网膜神经上皮下积液的存留延缓视力的恢复,手术方式对最终的视力恢复影响不大.     

Delayed absorption of subretinal fluid after scleral buckling procedures.

Delayed absorption of subretinal fluid beyond six weeks after surgical repair for rhegmatogenous retinal detachment was recognized in 39 of 575 consecutive cases of scleral buckling. The most common preoperative condition was large clumps of cells on the undersurface of the detached retina (subretinal precipitates). Approximately one in four patients in whom precipitates are seen preoperatively will have fluid persisting beyond six weeks from surgical repair to complete absorption. A second relatively common condition associated with delayed fluid absorption that could be recognized before operation was long-standing peripheral (usually inferior) retinal detachment, which typically spared the macula, was associated with demarcation lines, and was caused by round atrophic holes with or without associated lattice degeneration. An analysis of subretinal fluid protein concentrations in 39 cases showed a positive relationship between protein concentration and duration of detachment. Pigment-laden macrophages in the subretinal space, possibly originating from the retinal epithelium, were common.     

Retinal blood flow changes in eyes with rhegmatogenous retinal detachment and scleral buckling procedures]

Bidirectional laser Doppler technique and monochromatic photography was used to measure the absolute blood flow rate (F) in the major superior or inferior temporal retinal arteries in 3 patients with rhegmatogenous retinal detachment, in 4 patients following unilateral scleral buckling procedures, and in one patient before and after removal of scleral buckling elements. In 2 of the eyes with retinal detachment, F in arteries supplying the detached portion of the retina was approximately 30% lower than in arteries supplying the attached portion. On average, F measured in the arteries supplying the detached portion of the retina in 2 patients was 8.9 +/- 1.3 microliters/min, 67% lower than normal controls. F measured in the arteries supplying the attached portion of the retina in 3 patients was 15.2 +/- 3.9 microliters/min, on average, 43% lower than in normal controls. In 4 patients who had undergone uncomplicated, unilateral scleral buckling procedures, F in an artery of the affected eye was compared with F in the corresponding artery of the fellow eye. F in the artery of the affected eyes was 8.7 +/- 3.2 microliters/min, on average, 59% lower than that of the fellow eyes (p less than 0.05), and 68% lower than in normal controls (p less than 0.0001). Removal of scleral buckling elements in one patient produced a 79% increase in F in the measured artery. Then, F returned to normal levels after removal of scleral buckling elements.     

Scleral buckling technique without retinopexy for treatment of rhegmatogeneous: a pilot study

PURPOSE: To evaluate the role of retinopexy in the surgical management of primary rhegmatogenous retinal detachment (RD) without proliferative vitreoretinopathy. The primary outcome was retinal attachment, and secondary outcomes were visual acuity results and complications. METHODS: A randomized controlled trial including 60 patients with RD caused by a break or a group of breaks no larger than one clock hour. Thirty eyes received no retinopexy (group 1), and 30 eyes received transscleral cryotherapy (group 2). An encircling buckle was placed in all eyes. In eyes with posterior breaks, segmental buckles were also added. In some eyes, subretinal fluid drainage or anterior chamber paracentesis and/or intravitreal air bubble injection was performed. RESULTS: No differences were found between the groups in terms of the preoperative clinical variables evaluated: age; sex; axial length; lens status; type, number, and location of breaks; extension of detachment; and macula status. There were no differences in the surgical procedures performed. The reattachment rate in group 1 was 90%, and in group 2, it was 87% (a difference that was not significant [P = 1.00]). Final visual acuity improved by two lines or more in 22 patients in group 1 and in 20 patients in group 2 (P = 0.317). CONCLUSIONS: Our results indicate that primary rhegmatogenous RD can be successfully treated with scleral buckling without retinopexy.