The effect of scleral buckling on accommodative amplitude

PURPOSE: To evaluate the effect of scleral buckling on accommodative amplitude. DESIGN: Non-randomized, prospective, double masked clinical trial in which the fellow eye of patients undergoing scleral buckling served as a control. METHODS: Patients who underwent scleral bucking for the management of retinal detachment in at least one eye were enrolled. Accommodative amplitude was measured monocularly 1 month and 3 months post operatively by two masked optometrists using a near-point “push” technique and minus-to-blur technique. Accommodative amplitude in eyes that underwent scleral buckle surgery were compared to their fellow eyes. Buckle type, buckle location, lens status and age were analyzed. Generalized Estimation Equations (GEE) were used to compare means and percentages between two groups. RESULTS: Seventy-four eyes of 37 patients were included in the study. Median age was 44 years old (range: 31–67 years old) and 68.4% of patients were male (n = 24). Two patients required bilateral surgery. Thirty-six of 39 operated eyes (92.3%) were phakic and three were pseudophakic. In phakic eyes there was a significantly higher amplitude of accommodation in operated eyes compared to their fellow eyes at post-operative month one (0.99 diopters, p value = 0.002) and three (1.17 diopters, p value = 0.001). The difference in accommodative amplitude in post-operative eyes compared to control eyes did not reach statistical significance in pseudophakic eyes nor did it differ between those who had an encircling band and those with a segmental buckle at both one and 3 months after surgery (p value = 0.37 and 0.38, respectively). In those with a segmental buckle, inferior fixation resulted in a larger difference in accommodative amplitude compared to control eyes than any other location fixation. Age under 40 years old and better post-operative best corrected visual acuity (BCVA) both correlated with greater difference in accommodative amplitude compared to fellow eyes. CONCLUSION: Compared to fellow eyes not undergoing surgery, those eyes that underwent scleral buckling had a greater accommodative amplitude with larger differences correlating with better post-operative BCVA and younger age.