J Korean Ophthalmol Soc.  2017 Mar;58(3):363-366. 10.3341/jkos.2017.58.3.363.

A Case of Surgical Treatment of Large-angle Esotropia after Scleral Buckling without Buckle Removal

• Kim WJ
• Jeong A
• Kim MM

• KMID: 2371921
• DOI: http://doi.org/10.3341/jkos.2017.58.3.363

Abstract

PURPOSE
Strabismus can occur after retinal reattachment surgery with scleral buckling (SB). We performed surgical treatment of a large-angle esotropia after SB without buckle removal and achieved good surgical outcome.
CASE SUMMARY
A 21-year-male revisited our clinic for surgical treatment of esotropia. He had cicatricial retinopathy of prematurity in the right eye, and retinal detachment developed when he was 4 years old. Retinal reattachment surgery was performed with a 360-degree encircling band, a radial buckle at the 8 o'clock position, and a circumferential buckle ranging from the 7 to 11 o'clock position. He was not available for follow-up 2 years after surgery due to a change of residence, but exhibited a 5 prism diopters (PD) esotropia at the last visit. He demonstrated 55 PD esotropia of the right eye in the primary position with limited abduction. Surgery was performed without buckle removal, as recommended by a retinal specialist. Under general anesthesia, a forced duction test revealed a restriction of the medial rectus of the right eye. Exploration showed extensive adhesions around both the medial and lateral rectus with the buckle. Careful adhesiolysis and dissection were performed. A 8-mm resection of the lateral rectus and a 6-mm recession of the medial rectus were performed. The patient demonstrated favorable ocular alignment, and the limited abduction of the right eye improved after surgery.
CONCLUSIONS
We report a case of surgical treatment of a large-angle esotropia after SB without buckle removal. This case can be helpful for surgeons planning the treatment of strabismus in patients who had undergone SB.

Keyword

Buckling; Esotropia; Retinal reattachment

MeSH Terms

Anesthesia, General
Esotropia*
Follow-Up Studies
Humans
Retinal Detachment
Retinaldehyde
Retinopathy of Prematurity
Scleral Buckling*
Specialization
Strabismus
Surgeons
Retinaldehyde

Figure

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  Figure 1 Preoperative motility findings. Preoperative images of the case in nine diagnostic position of gaze, demonstrating esotropia of the right eye with definitive abduction limitation.

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  Figure 2 Intraoperative findings. (A) Intraoperative image showed adhesions between the medial rectus and scleral buckle (arrow, after the separation of the medial rectus from globe). (B) Intraoperative image showed the lateral rectus after adhesiolysis. (C) The scleral buckle was observed after the separation of the lateral rectus (arrowheads).

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  Figure 3 Postoperative motility findings. Favorable postoperative ocular alignment and improvement of the limited abduction of the right eye 6 months after the surgical treatment.

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