Carlà Matteo Mario, Couturier Aude, Mottola Francesco, Cusato Mattia, Oreste Gianmarco, Campaniello Giorgia, Mateo Carlos, Rizzo Stanislao
Department of Ophthalmology, Rothschild Foundation Hospital, Paris F-75019, France; Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome 00168, Italy; Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy.
Department of Ophthalmology, Rothschild Foundation Hospital, Paris F-75019, France; University Paris Cité, Department of Ophthalmology, University Hospital of Lariboisière, APHP, Paris F-75010, France.
Surv Ophthalmol. 2025 Nov-Dec;70(6):1181-1190. doi: 10.1016/j.survophthal.2025.07.002. Epub 2025 Jul 9.
Scleral buckling (SB) has been a cornerstone in the surgical management of rhegmatogenous retinal detachment for decades, achieving success rates above 85 %; however, its impact on choroidal architecture and hemodynamics has been less thoroughly explored until recent advancements in ocular imaging techniques. We synthesize current evidence on the effects of SB surgery on choroidal structure and circulation, examining its implications for postoperative complications and exploring a potential link with the newly described spectrum of acquired venous overload choroidopathy (AVOC). Various imaging modalities including indocyanine green angiography, optical coherence tomography (OCT), and OCT angiography have demonstrated that SB induces both transient and sometimes persistent alterations in choroidal thickness, blood flow patterns, and vascular morphology, with encircling buckles showing more pronounced and enduring effects than segmental approaches. Notably, persistent subretinal fluid (PSF), a known complication following SB surgery, appears associated with alterations in choroidal architecture, particularly in eyes with preexisting pachychoroid features, suggesting potential overlap with the AVOC spectrum characterized by impaired venous outflow from the choroid. The mechanical indentation of the sclera by the buckle may compress vortex veins, disrupt the Starling resistor mechanism regulating choroidal fluid dynamics, and contribute to venous congestion, with implications for long-term visual outcomes. While vascular adaptations often mitigate these effects through the development of collateral circulation, in some cases, particularly with encircling bands, persistent choroidal alterations may contribute to complications like PSF. Further research is needed to establish a definitive link between SB-induced choroidal changes and the AVOC spectrum, which could significantly influence patient selection, surgical technique, and postoperative management strategies for RRD.
几十年来，巩膜扣带术（SB）一直是孔源性视网膜脱离手术治疗的基石，成功率超过85%；然而，直到眼部成像技术最近取得进展，其对脉络膜结构和血流动力学的影响才得到更深入的探索。我们综合了关于SB手术对脉络膜结构和循环影响的现有证据，研究其对术后并发症的影响，并探索与新描述的获得性静脉超负荷脉络膜病变（AVOC）谱之间的潜在联系。包括吲哚菁绿血管造影、光学相干断层扫描（OCT）和OCT血管造影在内的各种成像方式表明，SB会引起脉络膜厚度、血流模式和血管形态的短暂变化，有时甚至是持续变化，环形扣带显示出比节段性方法更明显和持久的影响。值得注意的是，持续性视网膜下液（PSF）是SB手术后已知的并发症，似乎与脉络膜结构的改变有关，特别是在已有厚脉络膜特征的眼中，这表明可能与以脉络膜静脉流出受损为特征的AVOC谱存在重叠。扣带对巩膜的机械压迫可能会压迫涡静脉，破坏调节脉络膜流体动力学的斯塔林电阻机制，并导致静脉充血，这对长期视觉结果有影响。虽然血管适应性变化通常通过侧支循环的形成来减轻这些影响，但在某些情况下，特别是使用环形带时，持续的脉络膜改变可能会导致PSF等并发症。需要进一步的研究来确定SB引起的脉络膜变化与AVOC谱之间的明确联系，这可能会显著影响视网膜脱离患者的选择、手术技术和术后管理策略。
