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Alla Kelly, Dara Koozekanani, Joseph Terry, Sandra Montezuma; The effect of scleral buckling surgery on choroidal thickness measured by enhanced depth optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4862. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess anatomical thickness changes in the choroid after a scleral buckling procedure for retinal detachment repair. Does compressing the sclera and vasculature cause a subclinical change in the choroidal thickness?
This cross sectional study examined adult subjects with a history of unilateral retinal detachment that was repaired with a scleral buckle. The subjects underwent bilateral enhanced depth spectral domain optical coherence tomography (ED OCT) to image the choroid. Analysis of the ED-OCT images was done manually using Image J software. The choroidal area in a 6 mm wide region centered under the fovea was measured and then divided by the 6 mm region length to obtain the average choroidal thickness over the region. Both eyes were measured in order to use the non-operative eye as an internal control.
Forty subjects were consented and completed ED OCTs during the recruitment period, and 23 subjects were analyzed. There were 2 female and 21 male subjects analyzed with an average age of 64 (range 45-80). Subjects were excluded due to poor imaging quality, incorrectly recruited patients (e.g. bilateral scleral buckle), or only one eye imaged. The choroidal thickness was 170.8+/-60.2 um (mean +/- SD) in eyes with scleral buckles and 175.1 +/-62.0 um in eyes without. The difference between the treated and control eye within each patient was 4.3 um (95% CI -40.9, 32.3), which was not statistically significant (p=0.811). Sub-analyses of encircling element width and time from surgery failed to show any statistically significant effect on choroidal thickness difference between eyes on the same patient.
There was no difference in choroidal thickness between scleral buckle eyes and control eyes. Wider elements were not associated with increased effect on choroidal thickness. This shows that the scleral buckle procedure, as done today, does not affect choroidal thickness in the macula. These results may be a reflection of the evolution of retinal detachment repair surgery, including the currently used sizes of buckles or encircling bands, the degree of indentation, and the less posterior positioning of buckles. These factors may lead to avoidance of vortex vein involvement from surgery.
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