Myopic Refraction With Scleral Buckle

A patient presented to my practice for a routine eye exam. His history contained nothing out of the ordinary, and neither did his initial findings, which were performed by a technician. His BCVA was 20/20 OU with a slightly more myopic refraction in the left eye.

Although he had related a normal history, I knew there was more to the story when I observed the retinal imaging that the technician had acquired. From the optomap image (Figure), taken with a Daytona Plus (Optos), it was clear that this patient had previously undergone retinal detachment repair surgery in his left eye.

Upon further questioning, the patient confirmed that he had experienced a retinal detachment and had had surgery to repair it many years earlier. He also disclosed that he had undergone LASIK several years before the retinal detachment occurred and had perfect vision in both eyes until a scleral buckle repair of the retinal detachment created monovision for him due to the resulting myopic refraction.

Although scleral buckling is no longer used as often as vitrectomy for repair of retinal detachment, studies show similar efficacy between the procedures, including when used in combination versus vitrectomy alone.^1,2 Whether a detachment is repaired by primary vitrectomy or scleral buckling, anatomic reattachment rates are quite high. However, there are advantages to performing modern vitrectomy—such as faster postoperative recovery, less time in surgery, and less difficulty for the surgeon performing the procedure—that may not have existed when this patient underwent scleral buckling surgery. As demonstrated with this patient, scleral buckling can cause a myopic refractive shift, whereas vitrectomy does not.

When clinically examining a patient who has had a scleral buckle or band inserted, we never get to see the whole retina at once. Ultra-widefield optomap imaging, capturing up to a 200° field of view, can provide a unique opportunity to see the forest and not just the trees, and thereby to gain a new perspective on treating patients such as this one.