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Decrease in anterior chamber depth noted up to 9 months after scleral buckling surgery
Ophthalmology. 2010;117(1):79-85.
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A decrease in anterior chamber depth may persist 9 months after scleral buckling surgery for uncomplicated rhegmatogenous retinal detachment, according to a study. Axial length increased postoperatively.
Reduced anterior chamber depth resulting from previous scleral buckling surgery may increase endothelial cell loss in patients undergoing phakic IOL implantation, the study authors said.
"In patients with prior [scleral buckling] surgery and who plan to have a myopic [phakic] IOL implanted, a dissection of the encircling element may be considered, if the anterior chamber has become too shallow, with the aim of preventing high endothelial cell loss," the authors said.
The prospective study included 38 eyes with a primary rhegmatogenous retinal detachment that underwent scleral buckling surgery with an encircling element and a radial or segmental buckle. A control group comprised 31 fellow eyes. Mean patient age was 58.5 years.
Investigators used anterior segment optical coherence tomography to measure anterior chamber depth and the IOLMaster (Carl Zeiss Meditec) to gauge axial length. Measurements were taken before surgery and 1, 3, 6, 9 and 12 months after surgery.
Study data showed that mean anterior chamber depth in treated eyes was 3.33 mm before surgery, 2.78 mm at 1 day after surgery, 2.99 mm at 1 week, 3.05 mm at 1 month, 3.07 mm at 3 months, 3.09 mm at 6 months, 3.08 mm at 9 months and 3.16 mm at 1 year. Anterior chamber depth was not significantly reduced in the control eyes.
Mean axial length was significantly increased during the entire study period, resulting in a mean myopic shift of 2.6 D at 3 months after surgery. Mean IOP increased significantly 1 day after surgery but was not elevated at ensuing follow-up points. No eyes developed secondary angle-closure glaucoma, the authors reported.
This study demonstrates decreased anterior chamber depth (ACD) as measured by anterior segment optical coherence tomography following scleral buckling surgery. The ACD returned to normal 1 year after surgery. The importance of this finding involves patients with phakic intraocular lenses because of the risk of corneal endothelial damage with a decreased ACD. Therefore, retinal surgeons should consider this factor when repairing retinal detachment (RD) associated with a phakic IOL. The authors suggest vitrectomy as an option for repair for RD when the ACD is less than 3.5 mm. The obvious problem with this approach is the formation of post-vitrectomy cataract. A simpler approach would be to avoid an encircling scleral buckle if possible. The risk of placing a phakic IOL following a scleral buckle can be avoided by simply waiting for 1 year for the ACD to return to baseline. I see no reason to cut an encircling band in such patients, particularly since maximal visual recovery after RD may take up to 1 year.
– George A. Williams, MD
OSN
Retina/Vitreous Board Member