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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 89-91

Spectral domain optical coherence tomography used to view and quantify choroidal vascular congestion in new subretinal fluid following encircling scleral buckling


1 Department of Ophthalmology, King AbdulAziz University, Jeddah, Saudi Arabia
2 Department of Ophthalmology, University of Toronto, Toronto, ON, Canada
3 Department of Ophthalmology, University of Montreal, Montreal, QC, Canada

Date of Web Publication15-Dec-2014

Correspondence Address:
Mohamed Haji
Department of Ophthalmology, King AbdulAziz University, Jeddah, Saudi Arabia

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.147027

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  Abstract 

Known complications of scleral buckling surgery for primary rhegmatogenous retinal detachment include choroidal detachment, vortex vein compression and anterior segment ischemia. Post-operative persistent subretinal fluid following scleral buckling surgery is thought to occur in as many as 55% of cases. Likely mechanisms include impaired retinal pigment epithelium (RPE) function, altered subretinal fluid composition, choroidal ischemia, incomplete drainage of subretinal fluid and altered choroidal blood flow. Indocyanine green (ICG) angiography, laser Doppler velocimetry and scanning laser Doppler flowmetry have showed altered choroidal blood flow, pulsatile ocular blood flow and choroidal venous drainage after scleral buckling.

Keywords: Macula on, new subretinal fluid, post scleral buckle choroidal congestion, thick choroid on SD-OCT


How to cite this article:
Haji M, Gizicki R, Rezende FA. Spectral domain optical coherence tomography used to view and quantify choroidal vascular congestion in new subretinal fluid following encircling scleral buckling . Saudi Surg J 2014;2:89-91

How to cite this URL:
Haji M, Gizicki R, Rezende FA. Spectral domain optical coherence tomography used to view and quantify choroidal vascular congestion in new subretinal fluid following encircling scleral buckling . Saudi Surg J [serial online] 2014 [cited 2021 May 14];2:89-91. Available from: https://www.saudisurgj.org/text.asp?2014/2/3/89/147027


  Introduction Top


Known complications of scleral buckling surgery for primary rhegmatogenous retinal detachment include choroidal detachment, vortex vein compression, and anterior segment ischemia. Postoperative persistent subretinal fluid following encircling scleral buckling surgery is thought to occur in as many as 55% of cases. [1],[2] Likely mechanisms include impaired retinal pigment epithelium (RPE) function, altered subretinal fluid composition, choroidal ischemia, incomplete drainage of subretinal fluid and altered choroidal blood flow. [3] Indocyanine green angiography, laser Doppler velocimetry and scanning laser Doppler flowmetry have showed altered choroidal blood flow, pulsatile ocular blood flow, and choroidal venous drainage after scleral buckling. [4]


  Case Report Top


A 16-year-old female, myopic (OD-4.00, OS-4.75), presented with chronic infero-temporal retinal detachment OS with two small holes in the 5 h 30 meridian. Best-corrected visual acuity (BCVA) was OD 20/20, OS 20/50, intraocular pressure was within normal limits, and the macula was not detached. She underwent scleral buckling surgery under general anesthesia 3 weeks later. No perioperative complications were noted. One-week postoperative, a new submacular fluid was clinically visible. Spectral domain optical coherence tomography (OCT) confirmed confluent subretinal fluid and showed increased choroidal thickness (reference OD: 205 ∝m subfoveal) with significant vascular congestion. On follow-up, gradual resorption of the subretinal fluid was seen clinically and on OCT, paralleled by reduced choroidal thickness and vascular congestion [Figure 1], [Figure 2], [Figure 3], [Figure 4]. The patient's final BCVA was OS 20/25.
Figure 1: Postoperative week 1, increased choroidal thickness with a new submacular fluid

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Figure 2: Postoperative week 6 showing reduction in choroidal thickness and sub macular fluid

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Figure 3: Postoperative week 22, further reduction of choroidal thickness and sub macular fluid without any intervention

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Figure 4: Postoperative week 38, complete resolution of the submacular fluid and normal choroidal thickness

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  Discussion Top


The cirrus high definition-OCT machine that we used in this case is a valid, reliable and noninvasive tool to measure choroidal thickness. The incidence of persistent subretinal fluid following scleral buckling has been reported as being as high as 55% and can persist for several months. [5],[6] The appearance or persistence of subretinal fluid postoperatively could be in part caused by vascular congestion. Increased choroidal vascular resistance and decreased venous drainage are contributing factors. Both seem to normalize over time following vascular redistribution.

Choroidal vascular congestion and increased choroidal thickness have been linked to surbretinal fluid in cases of central serous chorioretinopathy, nanophthalmos, idiopathic uveal effusion syndrome, and impaired RPE function in an experimental animal model.


  Conclusion Top


New subretinal fluid following scleral buckling surgery can be caused by choroidal congestion induced by the encircling silicone band. Spectral domain OCT with the appropriate protocol to view the choroid is an important noninvasive and accessible tool to appropriately evaluate the state and function of the choroid. [7]

Vascular redistribution occurs over the coming weeks to months, with resorption of subretinal fluid and normalization of choroidal thickness and vascular caliber. In most cases, visual acuity is ultimately unaffected.

Recognition of this process is important for the understanding of an unusual postoperative course and for patient counseling for scleral buckling surgery.

 
  References Top

1.
Benson SE, Schlottmann PG, Bunce C, Xing W, Charteris DG. Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment. Ophthalmology 2007;114:108-12.  Back to cited text no. 1
    
2.
Wolfensberger TJ, Gonvers M. Optical coherence tomography in the evaluation of incomplete visual acuity recovery after macula-off retinal detachments. Graefes Arch Clin Exp Ophthalmol 2002;240:85-9.  Back to cited text no. 2
    
3.
Sugawara R, Nagaoka T, Kitaya N, Fujio N, Takahashi J, Takahashi A, et al. Choroidal blood flow in the foveal region in eyes with rhegmatogenous retinal detachment and scleral buckling procedures. Br J Ophthalmol 2006;90:1363-5.  Back to cited text no. 3
    
4.
Takahashi K, Kishi S. Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment. Am J Ophthalmol 2000;129:191-8.  Back to cited text no. 4
    
5.
Seo JH, Woo SJ, Park KH, Yu YS, Chung H. Influence of persistent submacular fluid on visual outcome after successful scleral buckle surgery for macula-off retinal detachment. Am J Ophthalmol 2008;145:915-22.  Back to cited text no. 5
    
6.
Veckeneer M, Derycke L, Lindstedt EW, van Meurs J, Cornelissen M, Bracke M, et al. Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: Hypothesis and review. Graefes Arch Clin Exp Ophthalmol 2012;250:795-802.  Back to cited text no. 6
    
7.
Theodossiadis PG, Georgalas IG, Emfietzoglou J, Kyriaki TE, Pantelia E, Gogas PS, et al. Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively. Retina 2003;23:69-75.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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