|Year : 2013 | Volume
| Issue : 3 | Page : 180-182
Scleral buckling for the management of inferior stationary long-standing rhegmatogenous retinal detachment in the juvenile age group
Ahmed Abdel Azim Abdel Kader, Ahmed El-Sawy Habib
Department of Ophthalmology, Faculty of Medicine, Cairo University (Kasr El-Ainy Hospitals), Cairo, Egypt
|Date of Submission||15-May-2013|
|Date of Acceptance||15-Jun-2013|
|Date of Web Publication||28-Feb-2014|
Ahmed Abdel Azim Abdel Kader
4-7B Shattr Eltany Zahraa Elmaadi, 11435, Cairo
Source of Support: None, Conflict of Interest: None
A retrospective noncomparative interventional clinical case series was performed between 2009 and 2012.
Patients and methods
Fourteen eyes of 14 young patients with chronic inferior rhegmatogenus retinal detachment showing focal proliferative vitreoretinopathy, subretinal bands, demarcation line, and inferior retinal breaks were managed with a segmental circumferential inferior 180 silicone tire and a 360 encircling circumferential band.
Anatomical success was achieved in 13 eyes (92.86%), improved vision in nine eyes (64.29%), and stationary vision in five eyes (35.71%).
Scleral buckling proved safe and effective in the management of long-standing rhegmatogenous retinal detachment in a juvenile age group with subretinal fibrosis and focal surface proliferative vitreoretinopathy.
Keywords: Juvenile retinal detachment, long-standing retinal detachment, proliferative vitreoretinopathy, scleral buckling
|How to cite this article:|
Abdel Kader AA, Habib AE. Scleral buckling for the management of inferior stationary long-standing rhegmatogenous retinal detachment in the juvenile age group. J Egypt Ophthalmol Soc 2013;106:180-2
|How to cite this URL:|
Abdel Kader AA, Habib AE. Scleral buckling for the management of inferior stationary long-standing rhegmatogenous retinal detachment in the juvenile age group. J Egypt Ophthalmol Soc [serial online] 2013 [cited 2020 Feb 21];106:180-2. Available from: http://www.jeos.eg.net/text.asp?2013/106/3/180/127382
| Introduction|| |
Proliferative vitreoretinopathy (PVR) is the major and most hazardous complication of rhegmatogenous retinal detachment (RRD). Five to ten percent of all RRDs have PVR as its main complication. It represents the major cause of ultimate surgical failure . These were classified by the retina society terminology committee in 1983 and updated in 1991 ,.
Juvenile retinal detachment has special characteristics including slow presentation, incomplete posterior vitreous detachment, high PVR rates (40%), predisposing risk factors such as trauma, high myopia, Stickler's syndrome, previous intraocular surgery, familial exudative vitreoretinopathy, uveitis, and previous retinopathy of prematurity .
Both final retinal reattachment rates and visual acuity outcomes are lower than those with adult surgery .
Chronic or long-standing retinal detachment has known features of retinal thinning, secondary retinal cysts, subretinal RPE proliferation demarcation lines (high water marks), and development of PVR .
| Patients and methods|| |
Fourteen eyes of 14 patients treated by two surgeons between 2009 and 2012 were evaluated retrospectively on the basis of the following criteria.
Long-standing inferior RRD affecting the macula partially with a demarcation line (water marks) within the margin of detachment. The detachment showed subretinal bands, a nonbullous configuration, and no more than single focal surface PVR formation not extending more than one clock hour (PVR grade C posterior-focal, subretinal).
Routine preoperative examination including visual acuity, slit-lamp biomicroscopy, applanation, and fundus examination using indirect ophthalmoscopy and 90 diopter lens biomicroscopy was performed.
The duration of detachment ranged from 1 to 4 years according to history, mean 14.5 months.
The mean age of the patients was 21±4.14 (range 6-32 years).
There were 10 males and four females.
Possible risk factors for detachment in history and examination
High myopia: five eyes (35.71%).
Trauma: eight eyes (57.14%).
Family history: one patient (7.14%).
Previous surgery: one pseudophakic (7.14%) and one aphakia (7.14%).
Preoperative best corrected visual acuity (BCVA)
Mean: 0.065 (range 0.016-0.2)
Multiple (2-6) inferior retinal holes were present in 13 eyes (92.86%), inferior horseshoe break in two eyes (14.29%), inferior dialysis in one eye (7.14%), inferior lattice degeneration in four eyes (28.57%), retinal cysts in two eyes (14.29%), and pigmentary clumps in two eyes (14.29%).
All cases were done under general anesthesia. Conjunctival periotomy 360° was performed; bridling of four recti was then performed with 4-0 silk. Gentle cryopexy was then applied to detected localized breaks followed by marking of breaks. Combined inferior circumferential segmental solid silicone tire 287 was applied for inferior 180° with 360° encircling solid band 240 was performed for all cases. Circumferential buckle was preferred to the use of radial buckle elements for many reasons. First of all these cases with inferior stationary RRD has small peripheral breaks with minimal risk of fish-mouthing under circumferential buckle. Second, breaks are usually multiple and placing inferior radial elements would affect extraocular muscle motility. Third, there is high risk of buckle exposure and extrusion with inferior radial buckles.
External drainage was performed for 10 eyes (71.43%). Drainage was not preferred in four cases with shallow fluid to avoid drainage complications in such cases.
Air tamponade was used in five eyes (35.71%); an SF6 nonexpansile mixture was used in three eyes (21.43%).
Patients were evaluated at 1 week, 1 month, and 3-6 months for visual acuity, eye inflammation, and anatomical retinal attachment.
Our primary assessment outcome was intraoperative complications, anatomical success in attaching retina, visual acuity improvement, and need for resurgery.
The secondary assessment outcomes were incidences of complications such as cataract, glaucoma, and late recurrences.
| Results|| |
Successful attachment was achieved in 13 eyes (92.86%) and one eye failed to reattach with stationary vision (7.14%) and no secondary intervention.
Mean BCVA: 0.16 (range 0.016-0.5).
Improved vision: nine eyes (64.29%).
Stationary vision: five eyes (35.71%).
None of the patients had worsened vision.
Intraoperative and early postoperative complications: no significant complications were recorded.
Late postoperative complications
Cataract: one phakic patient (7.14%) needed phacoemulsification 1 year after buckling.
High intraocular pressure (IOP) was observed in two patients (14.29%) and they required chronic use of single antiglaucoma medication [Figure 1].
| Discussion|| |
A century ago, RRD was untreatable. The treatment of RRD has advanced considerably since the pioneering work of Gonin . There is a broad agreement on the best method for the treatment of some categories of detachment. However, for the majority of cases, there is both lack of agreement and lack of an evidence base in terms of choices of technique. Moreover, as Wilkinson stated, 'The best method of repairing a particular detachment will remain a matter of speculations and bias until more appropriate data are acquired' ,.
In our study, we retrospectively reviewed 14 eyes that were subjected to the scleral buckling procedure. There is considerable controversy on the ideal surgical procedure for such cases. We believed that scleral buckling would achieve success. These cases had the following common features: young age group with inferior long-standing RRD. We believed that pars plana vitrectomy would be inferior to scleral buckling for the management of such cases. Our consensus came from incomplete posterior vitreous detachment with tightly adherent vitreous, inferiorly located retinal tears between 4 and 8 o'clock hours, difficult to tamponade interiorly by gas or silicone oil, presence of PVR tractional element with a high possibility of recurrences after internal removal, and avoidance of complications associated with silicone oil tamponade use in such juvenile patients.
Other possible lines of treatment such as conservative follow-up or laser demarcation for stationary detachment were not adopted because of macular involvement ,.
The results of our study supported our management with a success rate of 92.86%. However, visual improvement was low, with a mean improvement of one line and in 64.29%. This can be attributed to the long duration of elevated macula causing permanent photoreceptor damage and chronic cystoid macular edema ,,.
Comparing our results with the literature, James et al.  reported 57.1% success in  chronic RD cases and 86% success in fresh RRD.
Yao et al. , in a study of 36 eyes with chronic RRD managed by buckling, reported 90% successful attachment and visual improvement in 77.5% .
Ozdek et al.  found conventional surgery safe and effective in the treatment of inferior chronic RRD with subretinal bands.
| Conclusion|| |
Conventional scleral buckling for long-standing juvenile inferior RRD proved effective and safe. Further studies are required for comparison of vitrectomy in such cases.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
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