Ciliary body edema after scleral buckling surgery for rhegmatogenous retinal detachment.

摘要

PURPOSE: Choroidal detachment and anterior chamber (AC) shallowing develop in some cases after scleral buckling surgery for rhegmatogenous retinal detachment (RD). Postoperative angle-closure glaucoma has been reported to occur in 4% of cases. It is supposed that compression by the local scleral buckling induces ciliary body edema and angle narrowing. This study aimed to evaluate quantitatively the time course of changes in ciliary body thickness and AC depth (ACD) before and after the scleral buckling procedure using ultrasound biomicroscopy. DESIGN: Prospective consecutive case series. PARTICIPANTS: Forty-six eyes of 44 patients (43.7+/-18.1 years old [mean +/- standard deviation]) undergoing rhegmatogenous RD surgery. METHODS: Ciliary body thickness and ACD were measured before and 3, 7, 14, and 28 days after the procedure. Ultrasound biomicroscopy was used to evaluate ACD and ciliary body thickness. MAIN OUTCOME MEASURE: Time course of changes in ciliary body thickness and ACD. RESULTS: The surgerycaused significant increases in ciliary body thickness at 3, 7, and 14 days postoperatively (P<0.0001, Bonferroni multiple comparison). Ciliary body edema reached its peak 3 days after surgery, followed by a gradual decrease thereafter. Ciliary body thickness in the encircling group was statistically greater than in the segmental buckling group at 3 and 7 days postoperatively (P<0.001, Student's t test). The ciliary body was significantly thicker in the direction of buckling than on the opposite side 3 days after surgery (P = 0.0079). In the encircling group, retinal reattachment surgery significantly decreased ACD 3 days after surgery (P = 0.018), whereas no significant fluctuations were found in the buckling group. CONCLUSIONS: Even without apparent choroidal detachment and a shallow AC, subclinical ciliary edema existed in all directions of all eyes for at least 1 month after the scleral buckling procedure. The ciliary body in the direction of scleral buckling showed greater edema than the other areas. Eyes treated with the encircling band showed greater ciliary edema than those treated with segmental buckling alone.