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

Abstract

Purpose We conducted a study to investigate: (1) deviations caused by retinal detachment (RD) repair; (2) correlation between visual acuity and the number of surgeries to deviation size; and (3) differences between deviations following scleral buckling (SB) and pars plana vitrectomy (PPV). Methods A retrospective analysis of patients with persistent binocular diplopia following RD repair. Magnitude of manifest deviation (|dev|) in the primary position (PP) and position of greatest deviation (maxDev) was calculated. LogMAR acuity and number of previous vitreoretinal procedures were correlated to |dev| in both PP and maxDev. Manifest |dev| were compared between SB and PPV groups. Results Twenty-five patients were identified. The median |dev| was 7 prism diopters (PD) in PP and 17 PD in maxDev. We found no association between number of surgeries or VA with |dev| in either the PP (r ¼ À0.18 and r ¼ 0.08) or maxDev (r ¼ À0.26 and r ¼ À0.05). Twelve patients underwent PPV: median |dev| in PP 6 PD and maxDev 9 PD. In the SB group: median |dev| in PP 8 PD and in maxDev 22 PD. |dev| in PP showed no significant differences between PPV and SB (U ¼ 63, P ¼ 0.41); however, |dev| in maxDev, showed that SB have significantly greater deviations (U ¼ 36.0, P ¼ 0.02). Conclusion We report the largest cohort of patients with symptomatic ocular motility defects following PPV. We show no association between VA or number of procedures to strabismus magnitude. Ocular deviations in maxDev are significantly greater after SB procedures.

Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

“…Previous studies, though, have shown a similar incidence between SB and PPV, with SB patients having slightly larger prismatic deviations. [14] Additionally, the type of anesthesia may play a role in postoperative strabismus with direct inoculation of the rectus muscle with anesthesia, however, we did not see an effect on postoperative strabismus in our series between the types of anesthesia (retrobulbar versus sub-tenon's versus general anesthesia, p = 0.15).…”

Diplopia following retinal detachment repair: prisms or surgery long term?

“…6 A study proposed that when there are no obvious restrictions to eye movements or a reported macular translocation, patients who had weak fusional reserves before the retinal detachment may experience post-operative diplopia because they do not having the capacity to adapt following surgery. 7 From the UHG experience it can be stated that all patients experienced vertical diplopia rather than horizontal diplopia, and this could be linked to smaller vertical fusional reserves. This experience is similar to a study of 821 patients who underwent scleral buckling surgery: post-operatively 12 patients developed diplopia (1.5%), with 10 of these reporting vertical diplopia (83%).…”

Post-vitreoretinal Surgery Strabismus—A Review

“…The strabismus that developed following scleral buckling showed no significant difference in magnitude when measured in the primary position to that measured post-vitrectomy, however the ocular deviation was significantly greater when comparing the maximum deviation measured between the two groups. 19 Torsional diplopia was a consequence of macula translocation. Sato reported on 32 patients, 5 having peripheral fusion and 3 with gross stereopsis.…”