Motility and binocularity outcomes in vitrectomy versus scleral buckling in retinal detachment surgery

• Published in: Graefe's archive for clinical and experimental ophthalmology 1999-12, Vol.237 (12), p.1028-1032
• Main Authors: WRIGHT, L. A, CLEARY, M, BARRIE, T, HAMMER, H. M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aniseikonia - etiology; Aniseikonia - physiopathology; Biological and medical sciences; Diplopia - etiology; Diplopia - physiopathology; Eye Movements; Female; Humans; Male; Medical sciences; Middle Aged; Ocular Motility Disorders - etiology; Ophthalmology; Retinal Detachment - physiopathology; Retinal Detachment - surgery; Retrospective Studies; Scleral Buckling - adverse effects; Strabismus - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Treatment Outcome; Vision, Binocular; Vitrectomy - adverse effects
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s004170050340

Ocular motility defects and loss of binocularity are well-recognised problems following retinal detachment surgery. It is presumed that scleral buckling is primarily responsible for these effects. The increasing use of vitrectomy in the management of retinal detachment might be expected to reduce the incidence of these defects. Two groups of patients presenting with primary uncomplicated rhegmatogenous retinal detachments were examined following a single surgical repair. The first group underwent vitrectomy (n = 17), the second group, scleral buckling/external surgical techniques (n = 23). Heterotropia was present in 24% (n = 4) of the vitrectomy group and 30% (n = 7) of the "external" group, with suppression reported clinically in 8 of these and diplopia by the other 3. While ocular movements were frequently full (vitrectomy 59%, external 61%), restricted vertical movements were observed in 35% of the vitrectomy group and 26% of the external group, with horizontal and general restrictions being rare (6% and 13% respectively). True motor fusion was more common for the external group (44%) than the vitrectomies (24%), while superimposition was more frequent in the vitrectomies (64%; external 39%). The latter was achieved only with correcting prisms in 18% of vitrectomies and 9% of the external group. The remainder did not demonstrate any potential for binocularity. Visual symptoms were more frequent among the vitrectomy group, with aniseikonia and torsion significantly more common. The findings confirm that ocular motility problems are not exclusive to scleral buckling, with the incidence being similar in both groups. Slinging of the extraocular muscles and the accompanying dissection, resulting in the 'fat adherence syndrome', must be considered as contributory factors. The visual deficits which inevitably occur as the result of retinal detachment seem to play a more major role in the disruption of binocularity in these cases.