Incidence of Clinically Significant Aniseikonia Following Encircling Scleral Buckle Surgery: An Evaluation of Refractive and Axial Length Changes Requiring Intervention

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.

Absorbable suture for band tightening of scleral buckling in pseudophakic rhegmatogenous retinal detachment: a modified surgical technique and a 6-month follow-up

“…Vicryl exhibited an increasing hysteresis with ongoing degradation. Wilde et al [ 24 ] followed eyes that underwent combined pars plana vitrectomy and SB using a 5-0 Ethibond suture for the repair of RRD. AL measurements in the 33 included eyes revealed a significant increase in mean (SD) AL from 25.39 (1.27) mm preoperatively to 26.54 (1.16) mm postoperatively, with mean (SD) change in AL of 1.15 (0.67) mm over a mean postoperative follow-up period of more than 15 months [ 24 ].…”

“…Wilde et al [ 24 ] followed eyes that underwent combined pars plana vitrectomy and SB using a 5-0 Ethibond suture for the repair of RRD. AL measurements in the 33 included eyes revealed a significant increase in mean (SD) AL from 25.39 (1.27) mm preoperatively to 26.54 (1.16) mm postoperatively, with mean (SD) change in AL of 1.15 (0.67) mm over a mean postoperative follow-up period of more than 15 months [ 24 ]. Despite several differences between their study and ours, using absorbable Vicryl sutures to tighten the band instead of conventional permanent tightening revealed a significant decrease in AL from the baseline to each time point following the 2-week postoperative visit, and the final mean AL at the 6-month postoperative visit was 0.98 mm longer than the mean baseline value, with a significant improvement in functional and refractive outcomes.…”