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Takeshi Iwase, Misato Kobayashi, Kentaro Yamamoto, Hiroko Terasaki; Change in choroidal blood flow and morphology after segmental scleral buckling for rhegmatogenous retinal detachment?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5974.
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© ARVO (1962-2015); The Authors (2016-present)
Although scleral buckling is a well-established, anatomically successful surgical treatment for rhegmatogenous retinal detachment (RRD), the procedure can reportedly cause problems in the ocular circulation. We evaluated choroidal blood flow determined by laser speckle flowgraphy (LSFG) and morphological changes following segmental scleral buckling in eyes affected by RRD.
Segmental scleral bucking without a concomitant encircling procedure was performed on 46 eyes of 46 patients with successfully reattached macula-on RRD. Macular choroidal blood flow was assessed with LSFG using mean blur rate (MBR). Spectral-domain optical coherence tomography was used to image macular regions, to measure the subfoveal choroidal thickness (SFCT), and to calculate the luminal and the stromal areas by the binarisation method preoperatively and 1, 4, 8 and 12 weeks postoperatively.
In eyes affected by RRD, the mean macular choroidal MBR was 9.4 ± 3.2 arbitrary units (AU) before surgery, 10.1±3.7 AU at 1 week, 9.2±3.7 AU at 4 weeks, 9.0±3.1 AU at 8 weeks and 9.3±2.6 AU at 12 weeks following surgery. There was no significant change in macular choroidal MBR over time in the affected or unaffected opposite eyes. The mean SFCT in the operated eyes was 237.3±71.1 µm before surgery, 263.5±83.5 µm at 1 week, 240.1±70.3 µm at 4 weeks, 232.6± 55.9 µm at 8 weeks and 232.1±65.9 µm at 12 weeks following surgery. The mean SFCT at 1 week after surgery was significantly thicker than that before surgery (P < 0.001). The mean choroidal, luminal and stromal areas increased only at one week following surgery (P<0.001, P<0.001, P=0.025, respectively), while there was no significant difference in those areas in the fellow eyes throughout the follow-up period. The trend of SFCT with time coincided with that of the luminal area (P<0.001). Multiple regression analysis demonstrated that the SFCT postoperative week 1:preoperative ratio was positively correlated with that of the luminal area (P = 0.018).
Venous drainage obstruction induced by compression force of scleral buckling leads to SFCT thickening in the acute postoperative phase. The macular choroidal blood flow might be less susceptible to the partial compression force, because the blood flow does not change following segmental scleral buckling.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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