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Purpose: To describe a clinical entity called “rectus muscle pseudo?adherence syndrome” following buckling surgery. Methods: A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed. Results: The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre?op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post?op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow?up. Intraoperatively, in the absence of a buckle, the thinned?out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons. Conclusion: While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned?out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo?adherence syndrome, where the culprit is the healing process and not the muscle
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@#AIM: To investigate the correlation between macular mierostructure changes and visual outcomes after scleral buckling for macular-off primary rhegmatogenous retinal detachment(RRD)by three-dimensional optical coherence tomography(3D-OCT).<p>METHODS: Retrospective case review, the clinical data of scleral buckling in 30 eyes of 30 cases of RRD involving macular area were analyzed retrospectively. The changes of ellipsoid zone(EZ), external 1imiting membrane(ELM), subretinal fluid(SRF)and central retinal thickness(CRT)were observed and the relationship between them and best corrected visual acuity(BCVA)was analyzed by 3D-OCT at 2d, 2wk, 1, 3 and 6mo after operation.<p>RESULTS: Postoperative SRFH and CRT showed a descended trend. Postoperative BCVA showed an ascendant trend. Multiple comparisons: there were significant difference in each groups except SRFH(2wk <i>vs</i> 1mo, <i>P</i>>0.05), CRT(2d <i>vs</i> 2wk, <i>P</i>>0.05), BCVA(2d <i>vs</i> preoperation, 2wk <i>vs</i> preoperation, <i>P</i>>0.05). There are four forms of EZ and ELM::9 eyes, intact ELM and EZ(EZ+ELM+); B: 7 eyes, intact ELM with disrupted EZ:(EZ-ELM+); AC: 6 eyes, intact EZ with disrupted ELM:(EZ+ELM-); D: 8 eyes, disrupted ELM and EZ:(EZ-ELM-), the BCVA of the above four types are 0.15±0.04, 0.50±0.06, 0.54±0.05 and 0.59±0.09, there were significant difference in each groups except(C <i>vs</i> B, <i>P></i>0.05)and(C <i>vs</i> D, <i>P</i>>0.05). The incidence of SRF was 87% 2d after operation, 46.6% patients had persistent SRF at 6mo after operation. Postoperative CRT was positively correlated with postoperative SRFH.<p>CONCLUSION: After scleral buckling, the macular microstructure showed dynamic changes. The effect of SRF may be manifested as BCVA delayed recovery. With the slow absorption of SRF, CRT decreased and BCVA increased. The intact ELM or EZ shows better vision, but the disrupted ELM means worse vision.
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@#AIM: To investigate subfoveal subretinal fluid thickness(SFT)and subfoveal choroidal thickness(CT)after scleral buckling surgery(SBS)for macula-off rhegmatogenous retinal detachment(RRD).<p>METHODS: Retrospective observational case series. Twenty-three patients with macula-off RRD underwent successful SBS combined with cryotherapy. Patients with recurrent retinal detachment and proliferative preretinal membranes were excluded. Optical coherence tomography(OCT)was used to measure subfoveal SFT and subfoveal CT. The OCT images were then evaluated preoperatively and postoperatively at 1wk, 1, 3, 6, and 12mo. Best-corrected visual acuity(BCVA)was measured preoperatively and postoperatively.<p>RESULTS: All of the patients had subretinal fluid 1wk after operation. Subfoveal SFT gradually reduced over time. The subfoveal CT was thicker 1wk postoperatively and gradually decreased subsequently. The BCVA(mean±SD, LogMAR)was 0.60±0.35, which was a statistically significant change from the preoperative BCVA(<i>t</i>=6.35, <i>P</i><0.01).<p>CONCLUSION: The subretinal fluid was gradually absorbed with time, and the subfoveal CT gradually decreased after the early thickening. The SBS rapidly improved the visual acuity of the patients after the early postoperative period.
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@#AIM: To compare the postoperative outcomes after segmental scleral buckling(SSB)surgery with minimal <i>in situ</i> conjunctival incision(MCI)and conventional limbal conjunctival incision(LCI). <p>METHODS: Prospective randomized controlled study. Eighty eyes of 80 patients with rhegmatogenous retinal detachment(RRD)who received SSB surgeries in our hospital from August 2016 to November 2018 were recruited. They were randomly divided into two groups. Patients in control group were performed with conventional LCI, while patients in observation group received MCI. The length of the surgery, the retinal reattachment rate and the visual analogue scale(VAS)for evaluating the pain on the first postoperative day, questionnaire scoring method for evaluating the postoperative comfort level(including foreign body sensation and tearing)on the first, seventh, fourteenth, and thirtieth days were recorded. <p>RESULTS: The difference of surgery time between the control group and the observation group was statistically significant(<i>t</i>=2.057, <i>P</i><0.05). There was no significance in retinal reattachment rate between two groups. At the first day after surgery, the postoperative pain of the observation group was significantly lower than the control group(<i>P</i><0.05). At the first and seventh day after surgery, the observation group had higher postoperative comfort questionnaire score than the control group(<i>P</i><0.01), however, at the fourteenth and thirtieth day after surgery, the score was similar between the two groups(<i>P</i>>0.05). <p>CONCLUSION: Using MCI in SSB operation could shorten the operation time and significantly reduced postoperative pain and discomfort level.
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Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.
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@#AIM: To observe the efficacy of the minimal scleral buckling in the treatment of long-standing retinal detachment.<p>METHODS: The clinical data of 54 eyes in 54 cases of long standing retinal detachment treated by the minimal scleral buckling in our hospital during January 2014 to September 2018 were analyzed retrospective. Patients were followed up for 6mo. The rate of postoperative retinal reattachment, the best corrected visual acuity(BCVA), intraocular pressure, eye axis and astigmatism were observed. According to the preoperative time of retinal detachment, retinal detachment range, macular involvement or not and presence of PSF or not, the improvement of postoperative BCVA were analyzed.<p>RESULTS: The retina reattached in 49 eyes(91%)after primary operation. Postoperative persistent subretinal fluid was observed in 29 eyes of them by optical coherence tomography. At the last follow up, BCVA increased in 12 eyes(22.2%), remained unchanged in 38 eyes(70.4%), and decreased in 4 eyes(7.4%).The preoperative time of retinal detachment, retinal detachment range, macular involvement or not and presence of PSF or not had an impact on the postoperative recovery of BCVA.<p>CONCLUSION: The minimal sclera buckling surgery is an effective method to treat long standing retinal detachment. But postoperative visual acuity recovery is related to many factors.
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@#Rhegmatogenous retinal detachment is an eye disease that can lead to blindness. Timely and effective surgical treatment is the key to cure this disease, including pars plana vitrectomy and scleral buckling surgery, at present. Scleral buckling is a simple and effective treatment for the uncomplicated retinal detachment, but the recovery of visual acuity is influenced by many factors. The subretinal fluid is an important factor that can lead to the delayed recovery of visual acuity. This review is aimed at the present study of subretinal fluid after scleral buckling surgery.
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AIM: To retrospectively analyze selection of operation, surgery effect, complications and treatment methods of super high myopia combined with rhegmatogenous retinal detachment( RRD) . METHODS:A total of 47 cases(47 eyes) with the super high myopia patients combined with RRD who accepted scleral buckling of external pressure, vitrectomy combined silicone oil filling, or intravitreous gas injection were chosen in our hospital from Jan. 1, 2011 to Jan. 1, 2016. Best corrected visual acuity ( BCVA), intraocular pressure, retinal reattached rate, closure rate of holes and the postoperative complications of patients in half year were analyzed. RESULTS:Half a year postoperation, BCVA of twenty-four cases underwent vitrectomy combined silicone oil filling were improving(71%), and eight cases with scleral buckling surgery were enhanced ( 73%) . Statistical test showed the surgical treatment could significantly improve patients'eyesight, especially PPV with silicone oil, but the BCVA of patients with scleral buckling of external pressure in this study had no obvious significance according to the rank sum test. Compare with other surgery, pars plana vitrectomy( PPV ) combined silicone oil filling had more complications, such as high intraocular pressure and diplopia. CONCLUSION: The therapy of super high myopia patients with rhegmatogenous retinal detachment need many years' clinical experience, surgical skill of clinician and according to the number, the shape and the site of the retinal holes and area of detached retina, they need to choose the right means of surgery, and timely deal with postoperative complications, in order to improve the patients' postoperative retina, reset rate and visual function.
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AIM: To observe the effects of scleral buckling surgery for retinal detachment under microscope and under indirect ophthalmoscope. METHODS: Forty - six patients ( 46 eyes ) with rhegmatogenous retinal detachment were retrospectively analyzed. Twenty-six patients received surgeries under microscope was retrospectively analyzed and compared to that of 20 patients who received surgeries under indirect ophthalmoscope by the same operator. RESULTS: No statistical difference was found in patients' operation method choice, including condensation reaction reattachment situation and the retina reset operation at a time ( P> 0. 05 ). The best corrected visual acuity of microscopic group after 1mo of operation was better than before operation, and the improving rate of vision after operation was higher than that of the traditional group (P CONCLUSION:The curative effect of external approach microsurgery has the similar efficacy with the conventional external approach surgery, and gets better visual acuity.