The fluid mechanics of scleral buckling surgery for the repair of retinal detachment.
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.
Foster
William Joseph
WJ
Department of Physics, The University of Houston, 4800 Calhoun Road, Houston, TX 77004, USA. wfoster@uh.edu
Dowla
Nadia
N
Joshi
Saurabh Y
SY
Nikolaou
Michael
M
D016010:Binomial Distribution; D001826:Body Fluids / Q000502:physiology*; D020342:Finite Element Analysis; D006801:Humans; D008954:Models, Biological; D012163:Retinal Detachment / Q000601:surgery*; D012438:Saccades / Q000502:physiology; D012591:Scleral Buckling; D014783:Viscosity; D014822:Vitreous Body / Q000502:physiology