Post-vitreoretinal Surgery Strabismus—A Review

[Episcleral circular buckling in surgical treatment of recurrent rhegmatogenous retinal detachment after vitrectomy]

Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high.

PURPOSE

Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR).

MATERIAL AND METHODS

The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery.

RESULTS

Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil.

CONCLUSIONS

Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors

Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.

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

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.

Evolving trends in strabismus following retinal surgery: is there still a role for botulinum toxin?

Purpose Ocular motility disturbances following retinal detachment surgery are well documented, resulting in ocular misalignment and disabling diplopia. Interestingly, there has been a downward trend over the last decade across the United Kingdom with the evolution of refined vitrectomy techniques and instrumentation. We aim to report our updated experience on factors influencing botulinum toxin outcomes in view of the trend toward vitrectomy. Methods The Moorfields strabismus service carried out a follow-up retrospective study of all subjects that received botulinum toxin for retinal surgery-related strabismus at our center over an eleven-year period. All new onset constant or intermittent strabismus following retinal detachment surgery were included. Botulinum toxin response was stratified to good and poor. Results 32 patients fulfilled our criteria, with a mean follow-up of 20 months. The majority were vitrectomised eyes (62%), presented with diplopia (60%) and exotropia (66%). All isolated and combined vertical deviations (18%) were noted among cryobuckled eyes only. Baseline largest mean horizontal deviation was 49 and 51 prism diopters (PD) among the good and poor responders, respectively. A statistically and clinically significant reduction in the horizontal angle of deviation was noted among the good (p < .0001) responders, requiring a mean of six injections, in comparison to the poor responders (p = .03). Of the good responders, five patients (16%) with decompensated phorias regained fusion control. A small number of complications (15%) were noted, the most marked being intractable diplopia in a good responder (3%) with failure to fuse. Conclusions Botulinum toxin is a useful treatment modality, particularly when surgical options are limited. It can restore binocularity in patients with preexisting fusion potential. Ocular cosmesis can be achieved but requires ongoing injections. Barriers to fusion restoration include multiple retinal surgeries, persistent macula pathology and central-peripheral retinal rivalry. This highlights the need for rigorous baseline macula assessment to allow a tailored approach when considering botulinum toxin therapy for strabismus.

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

Purpose

To evaluate ocular movement disorders after scleral buckling surgery (SBS) for retinal detachment.

Methods

In this prospective, observational, case series, 206 patients (206 eyes) with rhegmatogenous retinal detachment who underwent SBS and investigated at the strabismus ward of Farabi Eye Hospital in Iran between November 2011 and November 2014 were assessed. Patients were followed from 6 to 36 months after SBS to evaluate for strabismus. Logistic regression analysis test and SPSS software version 20 were used for statistical analysis.

Results

From 206 patients, 56.8% were male, and 33.2% were female. For scleral buckle in 44.7% of patients, silicone band and tire (SBT) was used, and in 55.3%, a sponge. Among all patients, seven (3.39%) exhibited ocular movement disorder. There was no significant relation between type of buckle (P = 0.65) or the location of buckle (P = 0.56) and movement disorder.

Conclusion

Ocular movement disorder is one of the main complications after SBS without specific association between the type and location of exoplanet.

Strabismus surgery outcomes without removal of scleral buckle in patients with previous retinal detachment repair

PURPOSE

To report the motor and sensory outcomes of strabismus surgery following scleral buckle procedure for retinal detachment (RD) without removal of the scleral buckle.

METHODS

The medical records of patients who underwent strabismus surgery without removal of scleral buckle following RD surgical repair at a tertiary referral center between 2002 and 2015 were reviewed retrospectively. Demographic data were recorded, and rates of surgical motor success (defined as horizontal deviation of ≤10^Δ and vertical deviation of ≤4^Δ) and sensory success (resolution of diplopia) were calculated.

RESULTS

A total of 23 patients (mean age, 58.4 ± 24.4 years; 12 males) were included. The average time between the RD surgery and onset of strabismus was 11.05 ± 10.95 months (range, 1-42 months). The strabismus was horizontal in 6 patients, vertical in 2, and combined in 15. Eighteen patients (78%) presented with diplopia. Adjustable sutures were used in 18 patients. Final motor surgical success was achieved in 17 of 23 patients (74%), and diplopia improved in 17 of 18 patients (94%) who had preoperative fusional capability. There was no statistically significant difference in age, number of RD surgeries, macular status, time to strabismus surgery, visual acuity in the worse eye, or magnitude of preoperative horizontal and vertical deviation with regard to motor success rate and with persistence of diplopia postoperatively.

CONCLUSIONS

In our study cohort, strabismus surgery without removal of the scleral buckle resulted in motor success and alleviated diplopia in the majority of patients with prior RD repair.

Circumferential silicone sponge scleral buckling induced axial length changes: case series and comparison to literature

Background

This study compared axial length changes induced by circumferential scleral buckling using a silicone sponge with literature reports for solid silicone rubber.

Methods

Records of patients treated with scleral buckling in 2009–2013 using a silicone sponge, with preoperative axial length biometry measurements were reviewed. Additional information included age, type of surgery, additional surgeries, phakic status and anatomical success of reattachment. Patients underwent repeat biometry. The medical literature was reviewed for articles describing axial length changes induced by circumferential buckling using solid silicone rubber.

Results

Twenty-eight patients (mean age 49.7 years, range 16–72) met the inclusion criteria. Mean axial length was 25.38 mm preoperatively and 26.12 mm at least 6 months postoperatively (SD 0.50 ± 0.09, p < 0.001); a mean increase of 0.74 mm. Half the patients subsequently underwent cataract surgery. Post-operative changes were not significant compared to pre-surgical refraction and corneal astigmatism. Axial length change was not significant between sexes (9 women and 19 men).

Conclusions

Axial length changes induced by circumferential scleral buckling using silicone sponge exclusively are similar to those reported in the literature for solid silicone rubber buckles. Scleral buckling using a silicone sponge, which may offer several surgical advantages, induces an acceptable axial length change similar to that seen with widely-used solid silicone rubber buckles.