Risk factors influencing the outcome of strabismus surgery following retinal detachment surgery with scleral buckle

Abstract

Purpose To determine factors associated with surgical success in patients undergoing strabismus surgery after retinal detachment repair with scleral buckle. Methods The medical records of consecutive patients who underwent strabismus surgery after repair of retinal detachment with scleral buckle were retrospectively reviewed. A successful “motor” outcome was defined as horizontal deviation <10Δ and vertical deviation <4Δ in the primary position; successful “sensory” outcome was no diplopia in the primary position. Various factors such as removing the scleral buckle at the time of strabismus surgery, the macula structural status, size of the preoperative deviation, presence of restriction to passive movement, and whether the eye with the scleral buckle was the operated eye were compared among groups based on motor success. Results A total of 25 patients were included. The overall motor success rate was 72% after 1.8 ± 0.9 operations, with 62% of patients diplopia free in the primary position. Horizontal deviation <10Δ (P = 0.005) and minimal restriction on forced duction test were associated with motor success after the first surgery (P = 0.05). Partial or entire scleral buckle removal (n = 15) and fellow-eye surgery were not significantly correlated with motor success in our cohort. There were no retinal redetachments after scleral buckle removal. Conclusions A small preoperative horizontal deviation, and minimally restricted ocular rotations were associated with better results. Removing the scleral buckle did not improve results.

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

“…In one study, 50% of patients had resolution of the diplopia following buckle removal; 8 however, other studies found no benefit of buckle removal on the motor alignment and resolution of diplopia. 10,11 At UHG there have been 2 cases (40%) of diplopia following buckle removal. In this case the VR surgeon advised against the removal of the buckle due to the high risk of re-detachment.…”

“…9 A 20-year retrospective review of patients who underwent strabismus surgery following retinal detachment repair identified 25 patients; the average time between the retinal detachment surgery and the onset of diplopia was 4 months (range 0-42 months), and the average time between retinal detachment and strabismus surgery was 52 months (range 3-480 months). 10 All the patients had undergone scleral buckling procedures, and in addition 48% had cryotherapy. 10 A successful outcome from a single strabismus surgery was achieved in 36% of cases, increasing to a 72% success rate after multiple strabismus surgeries.…”

“…10 All the patients had undergone scleral buckling procedures, and in addition 48% had cryotherapy. 10 A successful outcome from a single strabismus surgery was achieved in 36% of cases, increasing to a 72% success rate after multiple strabismus surgeries. Multiple strabismus surgeries (2-4 procedures) were required in 52% of cases.…”

“…Multiple strabismus surgeries (2-4 procedures) were required in 52% of cases. 10 An adjustable suture surgery was performed in 85% of cases. 10 The authors concluded that smaller horizontal squints had better motor (BSV) outcomes ( p = 0.005), and those showing less restriction on forced duction testing were significantly associated with better BSV outcomes after one strabismus surgery ( p = 0.05).…”

“…10 An adjustable suture surgery was performed in 85% of cases. 10 The authors concluded that smaller horizontal squints had better motor (BSV) outcomes ( p = 0.005), and those showing less restriction on forced duction testing were significantly associated with better BSV outcomes after one strabismus surgery ( p = 0.05). 10 No association was reported between motor success and operation on the fellow eye ( p = 0.1) or scleral buckle removal ( p = 0.99).…”