Our Summary

This research paper discusses a case where a 54-year-old woman experienced eye pain and double vision after undergoing a combined eye surgery. The two procedures she had were a vitrectomy (removal of the clear gel that fills the eye) and a scleral buckling (a band placed around the eye to fix a retinal detachment). The study found that the band slipped forward due to the breakdown of tunnels in the eye where the band was placed. The slipped band was removed during a follow-up surgery which immediately improved the woman’s eye movement and relieved her pain and double vision. Her retina remained attached six months after the surgery. The paper concludes that doctors should be aware that the breakdown of these tunnels can occur, leading to a slipped band. Symptoms to look out for include painful eye movement, double vision, and a positive forced duction test (a test to determine if there is a mechanical restriction preventing eye movement). A CT scan can help confirm the diagnosis. Immediate surgery is necessary to reduce the patient’s discomfort and improve long-term eye movement.

FAQs

  1. What is scleral buckle slippage and what can cause it?
  2. What are the symptoms that may suggest a displaced scleral buckle?
  3. What is the recommended course of action if a displaced scleral buckle is suspected?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scleral buckle surgery is to be aware of any sudden onset of pain, diplopia (double vision), or restricted eye movements, as these may indicate a potential issue with the scleral buckle. It is important to seek immediate medical attention if any of these symptoms occur, as early diagnosis and intervention can help minimize discomfort and improve long-term outcomes. Additionally, follow-up appointments with the doctor should be scheduled to monitor the healing process and ensure the retina remains attached.

Suitable For

Patients who are typically recommended scleral buckle surgery are those with retinal detachment, particularly those with a high risk of proliferative vitreoretinopathy or a history of multiple retinal detachments. These patients may present with symptoms such as floaters, flashes of light, or a curtain-like shadow over their vision. Additionally, patients with significant myopia or trauma to the eye may also be candidates for scleral buckle surgery.

Timeline

Before Scleral Buckle Surgery:

  • Patient may experience symptoms of a retinal detachment, such as flashes of light, floaters, or a dark curtain covering part of their vision
  • Patient undergoes a comprehensive eye examination, including imaging tests such as ultrasound or optical coherence tomography (OCT) to confirm the diagnosis of a retinal detachment
  • Surgeon discusses the risks and benefits of scleral buckle surgery with the patient, and a surgery date is scheduled

After Scleral Buckle Surgery:

  • Patient may experience pain, discomfort, and blurred vision immediately after surgery
  • Patient is monitored closely in the postoperative period for signs of complications, such as infection or slippage of the buckle
  • Follow-up appointments are scheduled to assess the success of the surgery and monitor the healing process
  • Patient may experience improvements in their vision and symptoms of a retinal detachment, such as decreased floaters or improved visual acuity
  • Long-term follow-up is necessary to ensure the retina remains attached and to address any potential complications that may arise

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scleral buckle surgery?
  2. How long is the recovery period after scleral buckle surgery?
  3. Will I need to wear any special eye protection or take any specific precautions after the surgery?
  4. How likely is it for the scleral buckle to shift or slip, and what can be done if this occurs?
  5. Will I need any additional surgeries or follow-up procedures after the initial scleral buckle surgery?
  6. What kind of postoperative care and monitoring will be required after the surgery?
  7. How soon after the surgery can I expect to see improvements in my vision and eye symptoms?
  8. Are there any specific activities or lifestyle changes I should avoid after the surgery to prevent complications?
  9. How long can I expect the scleral buckle to remain in place, and are there any long-term considerations I should be aware of?
  10. Is there anything else I should know about scleral buckle surgery and its potential outcomes?

Reference

Authors: Nazari H, Emerson G, Tang PH. Journal: Retin Cases Brief Rep. 2023 Jan 1;17(1):41-43. doi: 10.1097/ICB.0000000000001104. Epub 2020 Dec 8. PMID: 33323898