Binocularity after retinal detachment surgery

Abstract

Study of ocular motility and of the relative visual acuity in patients who have been treated for retinal detachment emphasize the need for early treatment, especially when the macula is involved, and for selection of the simplest method of retinopexy that is thought to be adequate. It is important to avoid unnecessary trauma to the motor and suspensory system of the eye. Prismatic correction should be employed without delay in those patients who develop heterotropia after re-attachment of the retina.'1 seldom treat strabismus cases, but I often cause oculomotor trouble. When my operation is sucessful, my patients often get double vision', an outstanding retinal detachment surgeon once wittily remarked.Lack of binocularity is not uncommon after retinal detachment surgery and is more likely to occur with the more frequent use of operative methods that may considerably modify the shape of the eye. Yet diplopia and asthenopia are less common complaints in patients cured from retinal detachment -and with good vision in both eyes -than one would expect from the frequency of postoperative imbalance from damage to the motor and suspensory system of the eye, from irregular changes of the eyeball, or from macular heterotopia. * Policlinica Sagrado Corazon -Ophthalmic Department (Barcelona -Spain). Directors: Drs. A. ARRUGA and F. PALOMAR-PETIT.

Ocular movement disorders following scleral buckling surgery: A case series study

“…In this study, all seven patients underwent cryotherapy during SBS and had no serious side effect and complication. Arruga et al.’s study reported a direct relation between movement disorders and retrobulbar anesthesia because of its toxic effects on muscles and suggested subtenon injection as an alternative safer option 22 . In the current study, all patients with ocular movement disorder underwent general anesthesia while patients with retrobulbar anesthesia did not show any movement disorder.…”

Post-vitreoretinal Surgery Strabismus—A Review

“…Small-or medium-sized strabismus was seen in a further 26 patients. 11 Sewell described 19 out of 138 patients who developed symptomatic diplopia following retinal detachment repair. 8 Spencer studied 68 patients following scleral buckling surgery and 72% developed symptomatic diplopia.…”

Risk factors influencing the outcome of strabismus surgery following retinal detachment surgery with scleral buckle

“…Loss of fusion after retinal detachment due to decompensated heterophorias, poor vision or distortion due to macular damage, aniseikonia secondary to aphakia, or anisometropia from myopia induced by scleral buckle may lead to strabismus. 8-9 Additionally, the extraocular muscles may be directly damaged during retinal surgery by placement of the scleral buckle, 10 myotoxicity from retrobulbar anesthetic injection, 11 or cryotheraphy, 12-13 direct muscle injury 14 or malpositioning of a detached muscle. 14 Permanent adhesions and scarring from scleral dissection beneath a muscle insertion 15 or from orbital fat adherence 16 have also been implicated in postoperative strabismus.…”

“…8-9 Additionally, the extraocular muscles may be directly damaged during retinal surgery by placement of the scleral buckle, 10 myotoxicity from retrobulbar anesthetic injection, 11 or cryotheraphy, 12-13 direct muscle injury 14 or malpositioning of a detached muscle. 14 Permanent adhesions and scarring from scleral dissection beneath a muscle insertion 15 or from orbital fat adherence 16 have also been implicated in postoperative strabismus. These adhesions can manifest as complicated incomitant strabismic deviations with horizontal or vertical or torsional components 5, 17 and even as rare strabismus types such as Brown syndrome 8 or anti-elevation syndrome.…”