Incidence of ocular motility problems following scleral buckling surgery

Abstract

Nottingham SUMMARYThe incidence and severity of extraocular muscle imbal ance after conventional scleral buckling surgery was determined for 70 eyes of 68 patients with primary rheg matogenous retinal detachment. Fifty-eight eyes had cir cumferential silicone explants, 10 eyes had radial sponges and 2 had both. Sixty-five per cent of eyes showed some restriction of ocular motility and 72 % of patients had diplopia within their field of binocular single vision (BSV). The more extraocular muscles the explant was placed under, the more directions of gaze were likely to be restricted (p = 0.032). In 84% of eyes the restrictions could be related to the position of the explant. In 87% of patients their diplopia could also be related to the position of the explant. A second retinal detachment operation is more likely to cause restricted motility and more likely to cause diplopia within the expected field of BSV (p = 0.0297).Scleral buckling operations are known to cause post operative strabismus in some patients. Previous studies l -18 have quoted an incidence ranging from 3% to 57% of cases. Many authors have been unable to demonstrate a relationship to the type or position of the explant. One prospective study 19 demonstrates a higher incidence of muscle imbalance on detailed examination. Many of these studies include surgical techniques no longer in common use. This study evaluates the incidence and severity of extraocular muscle imbalance after retinal detachment surgery for primary rhegmatogenous detachment over a 2-year period. PATIENTS AND METHODSOne hundred and thirteen patients were identified from theatre records who had had primary rhegmatogenous ret inal detachment surgery between 1 January 1990 and 31 December 1991. Of these, 5 patients had moved away from the area, 18 had been secondary referrals from out side the catchment area, 3 further patients had died and 2 Eye (1993) 7, 751-756 had developed new ophthalmic problems which could affect ocular motility (namely dysthyroid eye disease and herpes zoster ophthalmicus). Two patients were untrace able on computer records. Of 83 remaining patients. invited to attend for full ocular motility examination 72 accepted. One was excluded from the study because of sympathetic ophthalmitis, and 3 more were excluded for incomplete data as the hospital records could not be found. The results from 68 patients (i.e. 82% of those invited) are therefore presented.From the patients' records the following data was col lected: (1) age, (2) sex, (3) previous history of strabismus, (4) history of previous ocular surgery, (5) best corrected visual acuity of affected eye and of the fellow eye as recorded, (6) whether the macula was detached, (7) ten otomy of any muscle at surgery, (8) location of the explant, (9) whether the explant was radial or circumferential, (10) size of explant, (11) whether diplopia had been a post operative complaint and whether any treatment had been required.The post-operative assessment was performed at least 7 months after surgery. Details of the ret...

Strabismus following retinal detachment repair: a comparison between scleral buckling and vitrectomy procedures

“…6,8,9 Regression analysis of our patients has not, however, shown an association between these variables and magnitude of strabismus.…”

“…3 The strabismus is reported greater with multiple VR procedures, encircling buckling elements rather than sectoral explants, and increasing number of muscles the explant is in direct contact with. 2,[5][6][7][8] The strabismus has been attributed to several mechanisms including globe distortion, fibrotic adhesions, mass effect on muscle pulleys, the effects of local anaesthetic (LA), and sensory disturbance. Macula off RD and reduced postoperative visual acuity (VA) are associated with poorer outcomes for binocular vision.…”

Post-vitreoretinal Surgery Strabismus—A Review

“…8 Spencer concluded that ocular muscle imbalance was related to the position of explant, and the more muscles the explant was placed under, the more directions of gaze were likely to be restricted. 1 They also showed that restriction was more likely to occur in the direction away from the buckle, suggesting tethering of the muscles, but can also occur towards the explant.…”

“…8 Spencer studied 68 patients following scleral buckling surgery and 72% developed symptomatic diplopia. 1 Waddell reported on 79 patients following scleral explant surgery and showed that only 24% had no diplopia or motility restriction. Thirty-three percent had symptomatic restrictions.…”

“…[1][2][3][4][5][6][7][8][9][10] Despite the advent of innovative treatments, it remains a problem. External scleral buckling procedures for retinal detachment are the vitreoretinal procedures most commonly reported to be associated with ocular motility disturbance.…”