Skip to main content

Controlled drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment: the pigment stream sign

International Ophthalmology volume 39, pages 1695–1701 (2019)Cite this article

Abstract

Purpose

To describe the macroscopic characteristics of the subretinal fluid (SRF) and its spilling modality during evacuative puncture in scleral buckling (SB) surgery for rhegmatogenous retinal detachment.

Methods

We retrospective reviewed all the SB surgeries performed over a period of 26 months at the University Eye Clinic of Trieste, Italy. We selected a cohort of 102 patients in which SRF drainage by means of evacuative puncture was performed. A high-definition video was recorded during the whole duration of the procedures, and the macroscopic characteristics of the SRF leakage were assessed.

Results

Pigmented dark-brownish deposits spilling in the fluid outcoming from the evacuative puncture was observed during the surgeries. In all cases, this macroscopic feature was detected during the late phases of the drainage. Moreover, indirect ophthalmoscopic evaluation showed the almost complete SRF drainage and a flattened retina at that moment.

Conclusions

The pigment stream sign, easily detectable by the surgeon, allows to understand, during the evacuative puncture, when the SRF has been drained almost completely and that the drainage procedure is therefore close to the end.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Schwartz SG, Kuhl DP, McPherson AR, Holz ER, Mieler WF (2002) Twenty-year follow-up for scleral buckling. Arch Ophthalmol 120:325–329

    Article  PubMed  Google Scholar 

  2. Ahmadieh H, Entezari M, Soheilian M, Azarmina M, Dehghan MH, Mashayekhi A, Sajjadi H (2000) Factors influencing anatomic and visual results in primary scleral buckling. Eur J Ophthalmol 10:153–159

    Article  CAS  PubMed  Google Scholar 

  3. Comer MB, Newman DK, George ND, Tom BD, Martin KR, Moore AT (2000) Who should manage primary retinal detachments? Eye (Lond) 14:572–578

    Article  Google Scholar 

  4. Heimann HM, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH, Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group (2007) Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114:2142–2154

    Article  PubMed  Google Scholar 

  5. Ryan EH Jr, Mittra RA (2010) Scleral buckling vs vitrectomy: the continued role for scleral buckling in the vitrectomy era. Arch Ophthalmol 128:1202–1205

    Article  PubMed  Google Scholar 

  6. Kuhn F, Aylward B (2014) Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res 51:15–31

    Article  PubMed  Google Scholar 

  7. Leaver PK, Chester GH, Saunders SH (1976) Factors influencing absorption of subretinal fluid. Br J Ophthalmol 60:557–560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lincoff H, Kreissig I (1972) The treatment of retinal detachment without drainage of subretinal fluid. (Modifications of the Custodis procedure. VI). Trans Am Acad Ophthalmol Otolaryngol 76:1121–1133

    CAS  PubMed  Google Scholar 

  9. Malagola R, Pannarale L, Tortorella P, Arrico L (2015) Drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment. G Chir 36:106–111

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Sasoh M (1992) The frequency of subretinal fluid drainage and the reattachment rate in retinal detachment surgery. Retina 12:113–117

    Article  CAS  PubMed  Google Scholar 

  11. Johnston GP, Okun E, Boniuk I, Arribas NP (1975) Drainage of subretinal fluid: why, when, where and how. Mod Probl Ophthalmol 15:197–206

    CAS  PubMed  Google Scholar 

  12. Hilton GF (1981) The drainage of subretinal fluid: a randomized controlled clinical trial. Trans Am Ophthalmol Soc 79:517–540

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Wilkinson CP, Bradford RH Jr. (1984) Complications of draining subretinal fluid. Retina 4:1–4

    Article  CAS  PubMed  Google Scholar 

  14. Freeman HM, Schepens CL (1975) Innovations in the technique for drainage of subretinal fluid, transillumination and choroidal diathermy. Mod Probl Ophthalmol 15:119–126

    CAS  PubMed  Google Scholar 

  15. Charles S (1985) Controlled drainage of subretinal and choroidal fluid. Retina 5:233–234

    Article  CAS  PubMed  Google Scholar 

  16. Raymond GL, Lavin MJ, Dodd CL, McLeod D (1993) Suture needle drainage of subretinal fluid. Br J Ophthalmol 77:428–430

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bovino JA, Marcus DF, Nelsen PT (1985) Argon laser choroidotomy for drainage of subretinal fluid. Arch Ophthalmol 103:443–444

    Article  CAS  PubMed  Google Scholar 

  18. Azad RV, Talwar D, Pai A (1997) Modified needle drainage of subretinal fluid for conventional scleral buckling procedures. Ophthal Surg Lasers 28:165–167

    CAS  Google Scholar 

  19. Yepez JB, Cedeño de Yepez J, Valero A, Arevalo JF (2004) Modified self sealing sclerotomy for drainage of subretinal fluid during scleral buckling surgery. Br J Ophthalmol 88:579–599

    Article  Google Scholar 

  20. Seo JH, Woo SJ, Park KH, Yu YS, Chung H (2008) Influence of persistent submacular fluid on visual outcome after successful scleral buckle surgery for macula-off retinal detachment. Am J Ophthalmol 145:915–922

    Article  PubMed  Google Scholar 

  21. Benson SE, Schlottmann PG, Bunce C, Xing W, Charteris DG (2007) Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment. Ophthalmology 114:108–112

    Article  PubMed  Google Scholar 

  22. McLeod D (1985) Monitored posterior transcleral drainage of subretinal fluid. Br J Ophthalmol 69:433–434

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Martin B (1975) Controlled release of subretinal fluid. Mod Probl Ophthalmol 15:149–153

    CAS  PubMed  Google Scholar 

  24. Patterson DF, Ryan EH (2013) Controlled drainage of subretinal fluid using continuous monitoring with indirect ophthalmoscopy. JAMA Ophthalmol 131:228–231

    Article  PubMed  Google Scholar 

  25. Brinton DA, Wilkinson CP (2009) Retinal detachment. Principles and practice, 3rd edn. Oxford University Press, New York, pp 149–180

    Google Scholar 

  26. Feldman BH, Wilkinson CP, Karth PA (2015) Scleral buckling for rhegmatogenous retinal detachment http://eyewiki.aao.org/Scleral_buckling_for_rhegmatogenous_retinal_detachment Accessed 15 Sept 2017

Download references

Author information

Affiliations

  1. Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazza Ospedale 1, 34129, Trieste, Italy

    Chiara De Giacinto, Marco Paoloni, Alberto Armando Perrotta, Marco Rocco Pastore, Rita Piermarocchi & Daniele Tognetto

Authors
  1. Chiara De Giacinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Paoloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Armando Perrotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Rocco Pastore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita Piermarocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Tognetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara De Giacinto.

Ethics declarations

Conflict of interest

Chiara De Giacinto declares that she has no conflict of interest. Marco Paoloni declares that he has no conflict of interest. Alberto Armando Perrotta declares that he has no conflict of interest. Marco Pastore declares that he has no conflict of interest. Rita Piermarocchi declares that she has no conflict of interest. Daniele Tognetto declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

10792_2018_988_MOESM1_ESM.wmv

High-definition video shows the evacuative puncture and the appearance of pigmented deposits in the subretinal fluid. (WMV 4872 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

De Giacinto, C., Paoloni, M., Perrotta, A.A. et al. Controlled drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment: the pigment stream sign. Int Ophthalmol 39, 1695–1701 (2019). https://doi.org/10.1007/s10792-018-0988-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-018-0988-x

Keywords

  • Rhegmatogenous retinal detachment
  • Scleral buckling surgery
  • Subretinal fluid drainage
  • Pigment stream sign
  • Evacuative puncture