Complications of Encircling

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Complications of encircling include surgery in all quadrants in all cases, increased myopia, strabismus, internal erosion, the string and

Fig. 3.3. Pathological specimen of an enucleated eye with a large buckle which had caused motility problems

purse-string syndromes as well as short- and long-term effects of choroidal ischemia and reduced pulse amplitude [17,18].

Some of these events can be controlled with careful technique. Conjunctival scarring and chronic dry eye can be reduced by meticulous attention to Tenon's capsule and careful dual layer closure. (It is unfortunate that closure is at the end of a challenging and tiring operation and is often delegated without much supervision). Strabismus can be reduced by careful handling of orbital tissues and muscle retraction and by choosing small instead of large buckles [19-21] (Fig. 3.3).

Meticulous restoring of the anatomy will limit scarring. Motility can be improved by postoperative ocular exercise. Erosion and string syndrome can be avoided by limiting constriction to 10% [22] (Fig. 3.4). Overzealous constriction ("high and dry") can be corrected later by cutting the band. More difficult post-surgical judgements are presented by insidious choroidal ischemia and reduced pulse amplitude [17,18]. Typically, the retina is attached and the vision is good yet there may be mild chronic irritation/

Vortex Vein
Fig. 3.4. Pathological specimen of an enucleated eye that had a tight encircling buckle which had covered the vortex vein ampullas. The retina was attached at the price of constriction and ischemia

inflammation and macular pigmentary changes that could also be ascribed to the original detachment or aging. It is difficult to propose to a patient that cutting the band at a small risk of re-detachment might prevent future macular changes and ill-defined degeneration; however, the intervention might prove more effective than daily antioxidants.

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