Our Summary

This research paper reports on a case where a woman developed a type of eye cancer (ciliochoroidal melanoma) at the same spot where she previously had a surgical procedure to repair a detached retina. The surgical procedure involved attaching a ‘scleral buckle’ to the outside of her eye. When the cancer was discovered, she was treated with a form of radiation therapy (Iodine-125 brachytherapy) that was delivered directly to the cancer site, without needing to remove or adjust the buckle. This treatment initially seemed to work well, but over four years, the woman’s vision gradually declined due to damage from the radiation (radiation retinopathy). The authors suggest that surgeons should consider how the materials used in procedures (like the silicone in the buckle) might affect radiation treatments, to avoid under-treating cancers.

FAQs

  1. Can a scleral buckle procedure increase the risk of developing eye cancer?
  2. Is it possible to treat eye cancer without removing or adjusting the scleral buckle?
  3. Can the materials used in scleral buckle surgery affect radiation treatments for eye cancer?

Doctor’s Tip

A doctor might tell a patient undergoing scleral buckle surgery to be aware of the potential risks and complications associated with the procedure, such as the development of eye cancer or radiation retinopathy. They may advise the patient to closely monitor their vision and report any changes or concerns to their healthcare provider promptly. Additionally, the doctor may recommend regular follow-up appointments to assess the health of the eye and ensure proper healing after surgery.

Suitable For

Patients who are typically recommended scleral buckle surgery are those who have a retinal detachment, which is a serious eye condition where the retina detaches from the back of the eye, leading to vision loss. Scleral buckle surgery is a common procedure used to repair retinal detachments by placing a band or buckle around the outside of the eye to support the retina and reattach it to the back of the eye.

In this case, the patient had a history of retinal detachment and underwent scleral buckle surgery to repair it. However, she later developed ciliochoroidal melanoma, a type of eye cancer, at the same spot where the buckle was attached. This suggests that patients who have had scleral buckle surgery may be at a higher risk for developing certain eye conditions, such as eye cancer.

It is important for patients who have undergone scleral buckle surgery to be regularly monitored by their ophthalmologist for any signs of complications or new eye conditions. Additionally, surgeons should consider the materials used in scleral buckle surgery and how they may interact with other treatments, such as radiation therapy, to ensure the best outcomes for patients.

Timeline

Before scleral buckle surgery:

  1. Patient experiences symptoms of a detached retina, such as flashes of light, floaters, or a curtain-like shadow over their vision.
  2. Patient undergoes a comprehensive eye examination, including imaging tests like ultrasound or optical coherence tomography (OCT), to confirm the diagnosis of a detached retina.
  3. Surgeon recommends scleral buckle surgery to reattach the retina, which involves placing a silicone band around the eye to provide support.
  4. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.

After scleral buckle surgery:

  1. Patient may experience discomfort, redness, or swelling in the eye immediately after surgery, which typically improves within a few days.
  2. Patient is prescribed medications to prevent infection and manage pain during the recovery period.
  3. Patient is advised to avoid strenuous activities and heavy lifting to prevent complications.
  4. Patient attends follow-up appointments with their surgeon to monitor the healing process and assess the success of the surgery.
  5. Patient may need further interventions, such as laser therapy or additional surgeries, to address any complications or residual issues related to the detached retina.
  6. Long-term follow-up is recommended to monitor for potential complications, such as cataracts, glaucoma, or in rare cases, the development of secondary conditions like ciliochoroidal melanoma.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scleral buckle surgery?

  2. How long is the recovery process after scleral buckle surgery?

  3. Will I need to undergo any additional treatments or procedures after the surgery?

  4. How likely is it that the scleral buckle could interfere with future treatments, such as radiation therapy?

  5. What is the success rate of scleral buckle surgery for repairing a detached retina?

  6. Are there any long-term effects or complications that could arise from having a scleral buckle implanted?

  7. How often will I need to follow up with my doctor after the surgery?

  8. Are there any lifestyle changes or restrictions I should be aware of after having a scleral buckle implanted?

  9. How will the presence of the scleral buckle impact my vision and overall eye health in the long term?

  10. Are there any alternative treatments or procedures that could be considered instead of scleral buckle surgery?

Reference

Authors: Motiani MV, Almanzor R, McCannel TA. Journal: Semin Ophthalmol. 2017;32(4):514-516. doi: 10.3109/08820538.2015.1115090. Epub 2016 Apr 15. PMID: 27082038