Objective To observe the clinical manifestations, therapeutic efficacy and results of bacterial culture of seven patients of scleral buckle (SB) infection after scleral bulking surgery. Methods Seven patients (seven eyes) underwent SB removal for SB infections were enrolled in this study. The patients included four males (four eyes) and three females (three eyes). The patients aged from 12 to 69 years, with a mean age of 42.7 years. There were four right eyes and three left eyes. The duration (interval between primary surgery and SB removal) ranged from two weeks to ten years, with a mean of 47.5 months. Six patients were concurrent with systemic disease. All the patients were examined for visual acuity, slit lamp microscope and indirect ophthalmoscope examination. Some patients also received external eye examination and fundus photography. Whether SB exposure or not and the clinical manifestations were observed. SB removal was performed in all the patients and the SB were sent to the laboratory for bacterial culture. The follow-up time ranged from two weeks to eight months, with a mean of 3.2 months. Whether infections recurrence and retinal detachment or not were observed. Results SB exposure was in three eyes. Obvious ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes; irritation and discharge were in one eye. No SB exposure was in four eyes. Ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes. Repeated subconjunctival hemorrhage and diplopia were presented in one eye. Visual acuity decline, conjunctival sac discharge and total retinal detachment were in one eye. All patients had no intraocular inflammation. The infection was controlled after SB removal and the retina was attached during the follow-up. The bacterial culture were all positive, which included Staphylococcus aureus, Staphylcoccus epidermidis and Erysipelothrix rhusiopathiae, Gram positive corynebacterium, Aspergillus flavus, Kocuria roseus, Streptococcus oralis, Maxwell Corynebacterium. Conclusions The clinical manifestations of SB infection and the pathogenic microorganisms are variable. SB removal can control the infection.
Objective To observe the changes of autoflurorescence (AF) in periphery retina after scleral buckling. Methods The examination of peripheral fundus autoflurorescence with Optos 200Tx was performed in 46 patients (46 eyes) who underwent successful scleral buckling. The correlation between changes of AF in surgical area and visual function were analyzed by multiple linear stepwise regression analysis.Results One week after surgery, completely atrophy of retinal pigment epithelium (RPE) with disappeared AF was found in the cryotherapy area of 15 eyes (32.6%), uneven area with enhanced AF and scattered weak AF spots was found in 31 eyes (67.4%). The area of RPE atrophy caused by cryocoagulation was 4 times larger than that of the primary retinal tear or holes in 9 eyes (19.6%), and was 2 to 4 times larger in 11 eyes (23.9%), and was 2 times less in the rest of 26 eyes (56.5%). A few granular hyper-AF was observed at the compressed retinal area in 11 eyes (23.9%), normal AF was observed at the compressed retinal area in 35 eyes (76.9%). When alpha;=0.05, the area with AF changes was significantly correlated with both vertical and horizontal diameter of peripheral visual filed (beta;=-0.024, -0.019; P＜0.001), but was not correlated with the best corrected visual acuity (F=0.51.22,P=0.312) by multiple linear stepwise regression analysis. Conclusions SBS can cause peripherial AF changes. Peripheral AF examination is helpful to evaluate the surgical retinal damage of scleral buckling.
Objective To measure the changes of eye shape and axial length of the eyeball before and after removing the scleral encircling buckles.Methods This is a prospective and controlled study. Twenty eyes (20 patients) with rhegmatogenous retinal detachment and the fellow eyes were enrolled in this study. All patients underwent scleral encircling buckling, and the buckles were removed 2.0-3.5 years after the surgery. The eye shape and axial length of both eyes were measured by three-dimensional computed tomography (3D-CT) before and one,three,six months after the removing surgery. The axial length was also measured by intraocular lens (IOL) Master.Results 3D-CT showed that buckled eyeball depressed at the equator, resulting in a gourd-shaped eyeball. One month after removing the encircling buckle the depression disappeared. By 3D-CT scanning, the axial lengths of buckled eyes were (27.65plusmn;1.22), (27.3plusmn;1.56), (27.29plusmn;1.46) and (27.12plusmn;1.49) mm before and one, three, six months after the removing surgery respectively. The difference between before and after removing surgery was not statistically significant (t=2.89,P=0.723). By IOLMaster, the axial length of operated eyes were (28.32plusmn;1.94), (28.17plusmn;1.87), (28.21plusmn;1.94), (28.25plusmn;1.93） mm respectively. The difference between before and after removing the encircling band was not statistically significant (t=3.304, P=0.93). There was no significant difference in these two measuring modes (t=3.705,P=0.847).Conclusions Encircling buckling can cause eyeball indentation, removing the encircling band can rescue the indentation. There are no changes in the axial length before and after removing the encircling buckles.