Indian Journal of Ophthalmology

ARTICLES
Year
: 1979  |  Volume : 27  |  Issue : 4  |  Page : 76--78

Complications after scleral buckling operation in rhegmatogenous retinal detachment


AK Mitra, A Goswami, IS Roy 
 Retina Research Centre, Medical College, Calcutta, India

Correspondence Address:
A K Mitra
Retina Research Centre, Medical College, Calcutta
India




How to cite this article:
Mitra A K, Goswami A, Roy I S. Complications after scleral buckling operation in rhegmatogenous retinal detachment.Indian J Ophthalmol 1979;27:76-78


How to cite this URL:
Mitra A K, Goswami A, Roy I S. Complications after scleral buckling operation in rhegmatogenous retinal detachment. Indian J Ophthalmol [serial online] 1979 [cited 2020 Sep 19 ];27:76-78
Available from: http://www.ijo.in/text.asp?1979/27/4/76/32581


Full Text

At present in rhegmatogenous retinal detachments excepting in very few cases some sort of scleral buckling along with cryo or diathermy retinopexy is the operation of choice. In most retinal centres buckling is usually done by non-absorbable material which can be used both intra and episclerally and for complete encirclement. Though more effective, the procedures are not free from complications.

 Material and methods



In the present study the complications observed in scleral buckling operation by non-absorbable material (silicon tire and band) in 200 cases of rhegmatogenous retinal detachments operated in the retina research centre, medical college, Calcutta from March, 1975 to March, 1977 are being discussed.

Observation

[Table 1] summarises types of buckling procedures. The [Table 2] shows the various post-operative complica­tions encountered in 200 cases.

 Discussion and comments



1. Oedema of the lids and chemosis of the conjunctiva

This is the commonest complication observed in 184 cases from the first operative day. It seems to be a reaction of the individual to the operative trauma and to the foreign material. Ordinarily no special treatment is needed for this, but when the reaction is severe a course of anti-inflammatory drug viz. oxyphenbutazone tablets orally helps. Presistent and severe oedema may arouse the suspicion of orbital cellulitis or anterior segment ischaemia. In the former condition along with severe local pain and fever, ocular movements become absent and in the latter the cornea and the anterior chamber become hazy.

2. Anterior segment necrosis

Four eyes have been lost in the series following this complication. The malady was diagnosed rather late, 72-96 hours after opera­tion. All these eyes were aphakic and had diathermy coagulation and regional intrascleral implant with 360° encirclage operation.

3. Secondary Glaucoma

In four cases this complication was observed on the 5th and 7th post-operative day respec­tively. Intraocular pressure was more than 50 mm of Hg (Schiotz). In one case the tension was controlled by I.V. mannitol and oral diamox tablets within 48 hours, but in the other case the tension became normal only after removal of the encircling band. The cause of this ocular hypertension is not clear.

4. Recurrent hyphaema

This was observed in two cases, who suddenly complained of severe pain and total hyphaema was observed. Immediately the blood was let out by paracentesis but the hyphaema recurred. Inspite of repeated para­centesis the source of bleeding could not be located and also hyphaema was not controlled. Ultimately the cornea becomes blood stained and the eye gradually becomes phthisical. Though localisation of the bleeding points were not possible, these are definitely from one of the anterior ciliary arteries which necrosed due to too much traction exerted on insertion of the recti muscle during operation.

5. Haziness of the vitreous

This is also a common complication (observed in 64 cases). It is usually observed after the 7th post-operative day when the vitreous suddenly appears hazy. Fortunately this disappears with usual anti-inflammatory treatment with atropine, local and systemic steroids. So it is presumed to be due to mild uveitis.

6. Restriction of ocular motility and diplopia

These complications occur in quite a number of cases (54 cases). The patients complain of diplopia 7-10 days after operation when the reactive oedema of the lids subsides and it is possible to open the eye freely. Usually this disappears within 2-3 weeks time but in one case it prolonged more than 3 months. Early restriction and diplopia is due to oedema of the muscles which is very common if the cryo-probe is applied under the muscle insertion. The case in which diplopia persisted for more than 3 months was most probably due to hinderance by the encircling band passing under the muscles.

7. Granuloma

This complication is not due to buckling surgery as it can occur after any ocular muscle surgery. In all 2.0 cases of the present series, the granuloma occurred at the site where the two ends of the encircling bands were tied over the sclera. The treatment is excision and cauterisa­tion of the granuloma.

8. Spontaneous extrusion of the implant

This happened in four cases which were intrascleral regional implants without encirclage. Fortunately, the retinal breaks remained sealed.

9. Persistant retrocular pain

This is complained by a number of patients (46 cases). Though it is not con­tinuous or intolerable but nagging and very much disturbing. Reassurance is the only treatment and fortunately it passes off in course of time or the patients learn to live with it. This is probably due to pressure of the buckle over the ciliary nerves passing through the sclera.

10. Enophthahnos (Seen in 140 cases)

This is almost a certain complication following 360° encirclage. This is most proba­bly due to retracting effect exerted by the recti muscles due to irritation by the encirling band.

11. Refractive change

190 cases following bukling operation show either an increment of myopia or decrease of hypermetropia and certain amount of astigma­tism. This is purely physical due to deformation of the globe by the buckle.

12. Development of secondary retinal tear

Secondary tears at the posterior border of the ridge were seen to develop in 30 cases of the series within 7 days to 6 months after success­ful buckling operation. In all these cases segmental intrascleral buckling with 360° encir­clage was done. The scleral beds were subjected to diathermy.

 Summary and comments



Complications observed in 200 cases following scleral buckling surgery in rhegmato­genous retinal detachment are discussed. Regional buckling produced much less compli­cations than total encirclage. The only drawback in regional buckling is that it sometimes becomes extruded as it happened in four cases. En­ophthalmos invariably follows 360° encirclage. The chances of secondary tears can definitely be minimised by judicious application of cryo instead of diathermy.