TY - JOUR
T1 - The fluid mechanics of scleral buckling surgery for the repair of retinal detachment
AU - Foster, William Joseph
AU - Dowla, Nadia
AU - Joshi, Saurabh Y.
AU - Nikolaou, Michael
N1 - Funding 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.
Funding Information:
Fig. 11 A comparison of subretinal fluid outflow with different eye movements. The simulated viscosity is that of water at 37.5°C. Note that the area under the curve represent ing rapid saccades, is consis tently the largest 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.
Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/1
Y1 - 2010/1
N2 - 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.
AB - 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.
KW - Fluid mechanics
KW - Retinal detachment
KW - Scleral buckle
KW - Vitreoretinal surgery
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U2 - 10.1007/s00417-009-1198-z
DO - 10.1007/s00417-009-1198-z
M3 - Article
C2 - 19809830
AN - SCOPUS:72449154571
VL - 248
SP - 31
EP - 36
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
SN - 0721-832X
IS - 1
ER -