Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study

Abstract

Purpose: To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Methods: Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. Results: Rhegmatogenous retinal detachment-diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall-, AQ-and UQ-MISHA further increased (p < 0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3 AE 2.8 and 15.5 AE 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p < 0.05). Rhegmatogenous retinal detachment-diagnosis (RRD-D), 1-and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p < 0.05). Conclusion: Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.Key words: anterior segment optical coherence tomography -in vivo confocal microscopy -intra-ocular pressure -rhegmatogenous retinal detachment -scleral buckling -unconventional aqueous humour outflow *Equally contributed to this work and share primary authorship.

Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera

“…Thus, we cannot be sure that scleral changes were clear signs of a uveoscleral outflow increase. However, given that such scleral features were previously proposed as AHUO biomarkers in a similar CB procedure (the UCP) and also in patients with rhegmatogenous retinal detachment [ 25 ], in which AHUO clearly increased, we think that our hypothesis is reasonable. Third, since AS-OCT cannot visualize structures located beyond the iris pigmented epithelium, we could not assess the effects of the procedure on the CB.…”

“…The MISHA and SR were calculated with Image J, which is an open-source software for processing and analyzing scientific images (Image J software, version 1.52°, , accessed on 1 September 2023). As previously defined, intra-scleral hypo-reflective spaces are intra-stromal features in which the sclera presents well-defined areas with less intense reflectivity than the surrounding regions [ 16 , 25 ]. These hypo-reflective spaces should be intended as areas where the scleral stroma is loosely arranged and less compact and, therefore, with probably lower hydraulic resistivity.…”

Changes in Iris Perfusion Following Scleral Buckle Surgery for Rhegmatogenous Retinal Detachment: An Anterior Segment Optical Coherence Tomography Angiography (AS-OCTA) Study

“…OCTA debut has mainly increased the assess of the retinal vasculature, preceding important papers described various applications of OCTA technology for non-invasive imaging of the AS [2,17,[27][28][29][30]. Ang et al [27][28][29] reported corneal and limbal vasculature changes using AS-OCTA providing interesting insights on pathologic corneo-limbal features such as postherpetic scarring and limbal stem cell deficiency [27][28][29].…”

“…Rhegmatogenous retinal detachment (RRD) represents a common cause of visual impairment secondary to separation of neurosensory retina from the underlying retinal pigment epithelium (RPE) [1]. The RRD development typically involves the association between posterior vitreous detachment and one or more retinal breaks causing the fluid passage through the retinal breaks into subretinal space [2,3].…”

“…Scleral buckling is a safe technique with a low incidence of perioperative and postoperative complications, however, several studies have highlighted the occurrence of a wide range of possible complications following surgery. These include glaucoma, choroidal detachment, eye movement disorder, infection and extrusion of the buckling material, and refractive changes [2,4,6]. Furthermore, previous histopathological studies have suggested that surgical manoeuvres during scleral buckling surgery (e.g., placement of encircling bands, compression of the eyeball, and cryotherapy to the scleral vessels) may result in an interruption of the blood supply to the anterior segment of the eye [2,[4][5][6][7][8][9].…”