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The fluid mechanics of scleral buckling surgery for the repair of retinal detachment

  • Retinal Disorders
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Abstract

Background

Scleral buckling is a common surgical technique used to treat retinal detachments that involves suturing a radial or circumferential silicone element on the sclera. Although this procedure has been performed since the 1960s, and there is a reasonable experimental model of retinal detachment, there is still debate as to how this surgery facilitates the re-attachment of the retina.

Methods

Finite element calculations using the COMSOL Multiphysics® system are utilized to explain the influence of the scleral buckle on the flow of sub-retinal fluid in a physical model of retinal detachment.

Results

We found that, by coupling fluid mechanics with structural mechanics, laminar fluid flow and the Bernoulli effect are necessary for a physically consistent explanation of retinal reattachment. Improved fluid outflow and retinal reattachment are found with low fluid viscosity and rapid eye movements. A simulation of saccadic eye movements was more effective in removing sub-retinal fluid than slower, reading speed, eye movements in removing subretinal fluid.

Conclusions

The results of our simulations allow us to explain the physical principles behind scleral buckling surgery and provide insight that can be utilized clinically. In particular, we find that rapid eye movements facilitate more rapid retinal reattachment. This is contradictory to the conventional wisdom of attempting to minimize eye movements.

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Acknowledgments

WJF acknowledges helpful discussions with Allan E. “Buzz” Kreiger, MD of UCLA, as well as support from the National Eye Institute of the United States National Institutes of Health (EY017112 and EY007551). ND acknowledges support from the University of Houston Provost’s Undergraduate Research Fellowship program.

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Authors and Affiliations

  1. Department of Physics, The University of Houston, 4800 Calhoun Road, Houston, TX, 77004, USA

    William Joseph Foster

  2. Department of Chemical Engineering, The University of Houston, 4800 Calhoun Road, Houston, TX, 77004, USA

    Nadia Dowla, Saurabh Y. Joshi & Michael Nikolaou

  3. Department of Ophthalmology, Weill–Cornell Medical College at The Methodist Hospital, Houston, TX, USA

    William Joseph Foster

Authors
  1. William Joseph Foster
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  2. Nadia Dowla
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  3. Saurabh Y. Joshi
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  4. Michael Nikolaou
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Corresponding author

Correspondence to William Joseph Foster.

Additional information

WJF received grant support from the National Eye Institute of the National Institutes of Health that provided partial salary support. ND acknowledges support from the University of Houston Provost’s Undergraduate Research Fellowship program that provided a stipend.

WJF has full control of all primary data, and all authors agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data, if requested.

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Foster, W.J., Dowla, N., Joshi, S.Y. et al. The fluid mechanics of scleral buckling surgery for the repair of retinal detachment. Graefes Arch Clin Exp Ophthalmol 248, 31–36 (2010). https://doi.org/10.1007/s00417-009-1198-z

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  • DOI: https://doi.org/10.1007/s00417-009-1198-z

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