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Daniel Simhaee, KaPo Yeung, Sarwar Zahid, Joseph Tseng, Kenneth Wald; Higher Rate of Anterior Segment Ischemia Observed in Patients with Retinal Detachments Treated with Vitrectomy and Scleral Buckle than Vitrectomy or Scleral Buckle Alone. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5069.
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Anterior segment ischemia (ASI) is a serious, uncommon, incompletely understood, complication of retinal detachment surgery. We performed a retrospective, observational clinical study to analyze the different rates of the development of anterior segment ischemia after various retinal detachment surgeries.
A retrospective chart review was performed including 466 patients who had retinal detachment surgery from 1/1/2009 until 9/22/14. The case rate of ASI was determined in each of three surgical groups: Encircling scleral buckle with pars plana vitrectomy (PPVSB), Vitrectomy (PPV) alone or Scleral Buckle (SB) alone. The encircling buckle used in all cases was a #40 silicone band.
283 (61%) patients had PPVSB, 123 (26%) had PPV alone and 60 (13%) had SB alone. Out of the 466 patients, 5 developed anterior segment ischemia. All occurred in the PPVSB group (p = 0.195). Of the 5 patients, all developed corneal edema and atrophy of the iris. All patients had residual chronic corneal edema with two requiring surgery. The scleral buckle height was not felt to be excessive in any case.
There is a higher rate of anterior segment ischemia in patients undergoing PPVSB than SB or PPV alone. Overtightening of the encircling band in vitrectomized and/or gas filled eyes could explain this phenomenon, although postoperative scleral buckle height is difficult to quantify. However, attention to intraoperative scleral buckle height during combined surgical cases may help reduce the risk of ASI.
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