Abstract
To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61; 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.
Highlights
Scleral buckle (SB) use with or without encirclement, combined with pars plana vitrectomy (PPV) remains controversial
This was done in an effort to identify any patients who were erroneously enumerated as a segmental buckle rather than encircling scleral buckle (ESB) during the theatre listing process
The authors reported that most of these patients remained asymptomatic, with aniseikonia only being detected with the New Aniseikonia Test [45]. Within this retinal detachment population, only a minority (6%) developed symptomatic anisometropia with aniseikonia following combined PPV, encirclement and endotamponade, which appeared to be the result of the refractive changes induced by the encirclement
Summary
Scleral buckle (SB) use with or without encirclement, combined with pars plana vitrectomy (PPV) remains controversial. The rationale, benefits, disadvantages and indications are often debated [1,2,3,4,5]. Many studies are non-randomised and retrospective, with inherent selection bias regarding treatment assignment. Studies often fail to record prevalence of early (grade A/B) proliferative vitreoretinopathy (PVR) among different treatment arms, making comparisons difficult [2]. A recent randomised controlled trial (RCT) demonstrated the advantage of additional encirclement in eyes with inferior breaks [6]. An older RCT suggested benefit for anatomical success among pseudophakic eyes with additional SB use during PPV [7]. Surgical techniques chosen for RRD repair remain highly variable, based on patient and ocular factors, but experience and preferences of surgeons along with equipment availability
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.