Abstract
Purpose: To investigate iris vasculature changes following scleral buckling (SB) surgery in eyes with rhegmatogenous retinal detachment (RRD) with anterior-segment (AS) optical coherence tomography angiography (OCTA). Methods: In this prospective study, enrolled subjects were imaged with an SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Image acquisition of the iris was obtained using an AS lens and a manual focusing adjustment in the iris using the retina imaging software. The quantitative analysis was performed in eight different iris regions: (i) superior, (ii) supero-temporal, (iii) supero-nasal, (iv) nasal, (v) temporal, (vi) inferior, (vii) infero-temporal, (viii) infero nasal which, were defined as squares with area of 1.5 mm2. Results: Fifteen eyes of 15 patients (six females; nine males) were included. Anterior segment optical coherence tomography angiography (AS-OCTA) parameters of the iris were statistically compared at baseline (preoperatively), 1 week, 1 month and 6 months after SB. At post-operative 1 week, perfusion density (PD) showed a significant decrease from 66.8 ± 13.2% to 58.55 ± 12.0% in the iris supero-nasal region (p = 0.016). However, at the 1-month follow-up visit, iris PD was significantly lower in all the analyzed iris regions, apart from the superior one. Conclusions: This study is the first description of AS-OCTA in patients undergoing SB. Our results showed a uniform reduction of the iris vessel network at 1 month after surgery, supporting the clinical use of AS-OCTA to identify early iris perfusion changes as potential predictive biomarkers of vascular disorders.
Highlights
Rhegmatogenous retinal detachment (RRD) represents a common cause of visual impairment secondary to separation of neurosensory retina from the underlying retinal pigment epithelium (RPE) [1]
The RRD development typically involves the association between posterior vitreous detachment and one or more retinal breaks causing the fluid passage through the retinal breaks into subretinal space [2,3]
Scleral buckling is a safe technique with a low incidence of perioperative and postoperative complications, several studies have highlighted the occurrence of a wide range of possible complications following surgery
Summary
Rhegmatogenous retinal detachment (RRD) represents a common cause of visual impairment secondary to separation of neurosensory retina from the underlying retinal pigment epithelium (RPE) [1]. Scleral buckling (SB) is still the first line surgical approach in primary RRD and for selected cases, despite the worldwide spread of vitrectomy in the last decades [4,5,6] This procedure involves an extraocular approach aimed at restoring contact of the RPE with the detached neuroretina [1,6]. Scleral buckling is a safe technique with a low incidence of perioperative and postoperative complications, several studies have highlighted the occurrence of a wide range of possible complications following surgery These include glaucoma, choroidal detachment, eye movement disorder, infection and extrusion of the buckling material, and refractive changes [2,4,6]. Previous histopathological studies have suggested that surgical manoeuvres during scleral buckling surgery (e.g., placement of encircling bands, compression of the eyeball, and cryotherapy to the scleral vessels) may result in an interruption of the blood supply to the anterior segment of the eye [2,4,5,6,7,8,9]
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