July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
SCLERAL BUCKLING FOR SEVERE POSTRAUMATIC HYPOTONY
NEW THERAPEUTIC APPROACH FOR TRAUMATIC CILIOCHOROIDAL DETACHMENT CONSEQUENCES
Author Affiliations & Notes
  • Eleonora Lavaque
    Retina , Hospital Oftalmologico Santa Lucia, Buenos Aires, Argentina
  • Mariano Iros
    Instituto de Microcirugia Ocular Cordoba , Cordoba, Argentina
  • Alberto Zambrano
    Fundación Zambrano, Buenos Aires , Argentina
  • Footnotes
    Commercial Relationships   Eleonora Lavaque, None; Mariano Iros, None; Alberto Zambrano, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5945. doi:
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      Eleonora Lavaque, Mariano Iros, Alberto Zambrano; SCLERAL BUCKLING FOR SEVERE POSTRAUMATIC HYPOTONY
      NEW THERAPEUTIC APPROACH FOR TRAUMATIC CILIOCHOROIDAL DETACHMENT CONSEQUENCES. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5945.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Purpose: Traumatic 360° or complete ciliochoroidal detachment (TCCD) produces ocular hypotony (OH). OH below 10 mmHg, reduces visual acuity due to hypotonic maculopathy (HM). Severe OH (SOH), below 5 mmHg, can progress to ptisis bulbis due to diffuse choroidal detachment.
TCCD treatments have shown discouraging results on the literature opposite to when it is localized in 1 or 2 quadrants
We evaluated an encircling scleral buckling procedure for the treatment of TCCD and its devastating consequences.

Methods : Methods:
Retrospective case series. Four (4) male patients with ocular contusion trauma presented SOH. Diagnosis of TCCD was confirmed by ultrabiomicroscopy (UBM).
Three (3) patients were naive of treatment and 1 had history of a previous unsuccessful vitrectomy with direct ciclopexy.
In the 4 cases an encircling scleral buckling procedure was performed by 3 different surgeons using the following explants: sponge Mira 503, E240, E40. Sutures with nylon 5-0 were done in the 4 quadrants, 2 mm back from muscles insertion and adjusted to produce a high indentation. One patient underwent vitrectomy and direct ciclopexy during the same surgical procedure.
Complete ophthalmic examination and UBM were done pre and postoperatively

Results : Results:Demographic, LogMAR BCVA, IOP mmHg and UBM pre and postoperative are shown in Table 1.
All patients improved their SOH status. In 3 patients IOP level returned to normal, HM dessapeared and BCVA improved to+0.10 or +0.00.
However, only one of these patients had resolution of TCCD.
In 1 patient, improvement of IOP (from 2 to 8 mm Hg), HM and visual acuity was observed although BCVA improvement was contrarrested by a posterior subcapsular 2+ development

Conclusions : Conclusions: In this retrospective case series, 4 patients with SOH secondary to TCCD were successfuly treated by an encircling scleral buckling. Normal IOP level was achieved in 3 cases with HM resolution and BCVA improvement.
This easy, safe, and worldwide known technique appears to be a therapeutic option with encouraging results.
Further studies are needed to guarantee this new therapeutic indication and its possible mechanisms.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

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