Scleral buckle removal: indications and outcomes

ABSORBABLE GELATIN SPONGE AS AN INTRASCLERAL BUCKLE IN RABBITS: A Pilot Study

PURPOSE

This study aimed to evaluate the efficacy and safety of using an absorbable gelatin sponge as an intrascleral buckle in rabbit eyes; it also monitored degradation of the gelatin sponge over time.

METHODS

Ten, New Zealand, White rabbits underwent surgery to implant an absorbable gelatin sponge as an intrascleral buckle. Weekly ophthalmic examinations were conducted before and after the procedure until the implant was fully absorbed. Assessments included external eye and fundus examinations, color fundus imaging, and optical coherence tomography. Safety and efficacy were determined by comparing preoperative and postoperative conditions.

RESULTS

The surgery was successfully completed in 12 of 20 eyes, yielding favorable postoperative outcomes. Eight eyes were excluded due to issues with scleral tunneling, including accidental penetration, suprachoroidal implantation of the sponge, and choroidal excavation, resulting in a success rate of 60%. The indentation produced by the gelatin sponge implant progressively decreased, entirely disappearing within 2 weeks. No complications, such as retinal or choroidal hemorrhage or detachment, were observed.

CONCLUSION

Intrascleral implantation of absorbable gelatin sponge was safe and effective for scleral buckling in rabbits, demonstrating favorable biodegradation characteristics.

Early Postoperative Conjunctival Complications Leading to Exposure of Surgically Implanted CorNeat EverPatch Devices

PURPOSE

To compare the early exposure and surgical revision rates between a new synthetic tissue substitute (CorNeat EverPatch) with that of human donor cornea after placement onto the scleral surface during ophthalmic surgery and study the biomaterial properties of the synthetic patch material.

DESIGN

Retrospective comparison study and biomaterial analyses of new and explanted synthetic patch material.

PARTICIPANTS

All consecutive patients who underwent ophthalmic surgery with implantation of the CorNeat EverPatch at the Wilmer Eye Institute (occurring from February through August 2024) and a comparison group who underwent ophthalmic surgery with implantation of irradiated donor cornea, matched 1:2 with patients receiving EverPatch for age, type of glaucoma, and surgeon.

METHODS

Retrospective review of clinical electronic medical records of patients who underwent surgery at the Wilmer Eye Institute. Materials characterization of EverPatch, including morphologic features, surface roughness, wettability, thermal stability, elemental analysis, and physical properties.

MAIN OUTCOME MEASURES

Early exposure (within 5 months of surgery) and surgical revision rates after CorNeat EverPatch or irradiated human donor cornea implantation during ophthalmic surgery.

RESULTS

Thirty patients undergoing ophthalmic surgery in 2024 received EverPatch implantation during primary tube shunt placement (n = 27), tube shunt revision (n = 2), or covering of exposed suture used for scleral fixation of an intraocular lens (n = 1). During the early postoperative period, the rate of EverPatch exposure was 48.3% and the rate of surgical revision was 27.9%. In case-matched control participants (n = 58), the rate of patch graft exposure was 1.7% (P < 0.0001) and the rate of surgical revision was 1.7% (P < 0.0001). EverPatch devices constituted a randomly aligned fibrous mesh with an average fiber diameter of 1.36 ± 0.78 μm, surface roughness of 1.3 ± 0.1 μm, pore size of 3.7 ± 0.4 μm2, and percent porosity of 37 ± 3%. Explanted EverPatch devices demonstrated varying degrees of tissue integration with significantly increased wettability and changes in thermal stability and elemental composition.

CONCLUSIONS

The rate of early conjunctival complications leading to exposure of the CorNeat EverPatch was higher than that of irradiated human donor corneal patch grafts.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Peripheral Retinal Ischemia and Secondary Neovascular Glaucoma after Cerclage for Retinal Detachment: A Case Report

Introduction

Various surgical techniques, including 360° buckling surgery with a retinal cerclage, have been employed to achieve retinal reattachment. Although retinal cerclage is generally effective, long-term complications can arise. Peripheral retinal ischemia and secondary neovascular glaucoma are rare, but serious complications can occur even years after successful retinal reattachment.

Case Presentation

We report a rare case of a 79-year-old woman who underwent 360° buckling surgery with cerclage for retinal detachment 10 years ago. Although the initial surgery successfully reattached the retina, she later developed a complication characterized by peripheral retinal ischemia and secondary neovascular glaucoma.

Conclusion

Early detection and prompt management of such complications are crucial to prevent irreversible visual impairment.

A Divergent Sequela of Scleral Buckle Removal

Scleral buckle (SB) removal is done for a variety of reasons following treatment of rhegmatogenous retinal detachments (RRD), such as buckle exposure, migration, and infection. The most worrying complication of SB removal is retinal redetachment. We report a unique case of a patient developing strabismus about one month after scleral buckle removal for anterior migration and exposure of the scleral buckle. We also share a successful strabismus surgery which had a main aim of relieving diplopia in the patient's primary gaze.

Surgically-Induced Necrotizing Scleritis After Scleral Buckling With Stenotrophomonas maltophilia Infection

Surgically induced necrotizing scleritis (SINS) is a rare inflammatory disease of the sclera that occurs following ocular surgery, specifically pterygium surgery and scleral buckling. Here, we report a case of SINS in a 78-year-old female patient after segmental scleral buckling for rhegmatogenous retinal detachment. The retina was restored after scleral buckling, and the postoperative course was uneventful. However, the patient developed ocular discharge and conjunctival hyperemia, indicating infection, after two months. The sclera became thinner and intraocular inflammation developed after buckle removal. Stenotrophomonas maltophilia was isolated from the ocular discharge, and the patient was treated with antibacterial agents susceptible to the bacteria. However, her symptoms persisted, and corrected visual acuity decreased from 20/25 to 20/1000. Oral steroid treatment was initiated because of the suspicion of SINS. Intraocular inflammation gradually subsided, the thin sclera was covered by conjunctival tissue, and the patient's corrected visual acuity improved to 20/32, which stabilized her condition. Infection with Stenotrophomonas maltophilia after scleral buckling is extremely rare, and SINS development in such cases is unprecedented.

Scleral Buckle Removal: Long-Term Patient Outcomes

PURPOSE

Scleral buckling has been a reliable treatment option in the repair of primary rhegmatogenous retinal detachments. Occasionally, patients require scleral buckles (SBs) to be removed for various reasons. While outcomes of SB removal have been investigated in this subset of patients, there has not been any large patient series to reach any conclusions. Long-term sequelae of SB removal are debated in the literature, specifically around the risk of redetachment.

DESIGN

We performed a retrospective, observational study to evaluate the clinical indications for, and outcomes of, SB removal.

PARTICIPANTS

No control patients in this retrospective, observational study.

METHODS

Eighty-six individuals with a history of SB removal from June 1, 2000, to January 1, 2021, were followed from a large academic center and a private, retina-only practice in Chicago. Exclusion criteria were age of < 18 years and unplanned or self-explanted SB removal.

MAIN OUTCOME MEASURES

Data extracted included patient symptoms before SB removal, indications for removal, resolution of symptoms following removal, rate of redetachment, and rate of additional ocular surgery. Secondary outcomes included identifying factors associated with poorer outcomes.

RESULTS

Eighty-six eyes with history of SB removal were included with an average follow-up of 4 years. Approximately 60% were males and the mean age at the time of SB removal was 59 years. Leading indications for removal were exposure (61.63%), infection (20.93%), and diplopia/strabismus (19.77%). The average time from SB placement to removal was 12.28 ± 11.16 years. Most patients requiring SB removal presented with symptoms, specifically of pain and discomfort (65.12%), diplopia (22.09%), and drainage/discharge (18.60%). Of these patients, 86.59% experienced symptom resolution following SB removal. Notably, 6.56% (4 eyes) of all eyes with at least 1 year of follow-up experienced a redetachment requiring surgery. Within this subset, the average time from SB placement to removal was 2.05 ± 2.01 years and time to redetachment following removal was 15.95 ± 25.71 months. Nine percent of all eyes required additional strabismus or oculoplastic surgery.

CONCLUSIONS

Scleral buckle removal provides a high rate of symptomatic relief and low risk of subsequent detachment. Nevertheless, close monitoring is warranted to monitor for recurrent retinal detachments.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Impact of macular buckle removal on the functional and anatomical outcomes of myopic macular hole associated retinal detachment

A man in his 70s presented with a 1-month history of vision loss in the right eye. His best-corrected visual acuity (BCVA) in the affected eye was limited to counting fingers at close range. The examination revealed a macular hole with associated retinal detachment in the right eye and features of pathological myopia in both eyes. A macular buckling surgery was performed and resulted in a successful anatomical and functional outcome. Postoperatively, at week 10, the patient developed diplopia and buckle exposure. Therefore, the buckle was removed. However, the patient maintained a BCVA of 20/250 with an attached retina and closed macular hole after 6 months of follow-up.

[Episcleral circular buckling in surgical treatment of recurrent rhegmatogenous retinal detachment after vitrectomy]

Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high.

PURPOSE

Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR).

MATERIAL AND METHODS

The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery.

RESULTS

Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil.

CONCLUSIONS

Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.

Comparison of Povidone-Iodine and Gentamicin Soak as Scleral Buckle Infection Prophylaxis

Objective

To determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.

Design

Experimental study.

Participants

Scleral buckle elements were soaked in either gram-positive or polymicrobial broth, while control buckle elements were soaked in PBS only.

Methods

Solid silicone and sponge scleral buckle elements were inoculated with common pathogens of the ocular surface, and then soaked in either 1% or 5% povidone-iodine, 1 mg/mL gentamicin solution, or sterile saline for 1, 5, 10, or 15 minutes. Bacteria were then isolated from the buckle elements and cultured for 24 hours.

Results

In all gram-positive bacterial conditions, gentamicin solution decreased the bacterial load from 451,666.67 colony-forming units (CFU)/mL to 171,611.11 CFU/mL (p=0.0004). The fractional bacterial survival after soaking in gentamicin was higher for the silicone sponge than band (0.357 vs 0.079, p=0.038). Both 1% and 5% povidone-iodine were able to completely eradicate all gram-positive bacteria of both buckle elements. Only 5% povidone-iodine was able to completely sterilize all microbes on the buckle after soaking in a polymicrobial solution consisting of gram-positive, gram-negative bacteria, and fungi.

Conclusion

Povidone-iodine solution was significantly more effective at bacterial eradication compared to gentamicin solution. For all scleral buckle procedures, we recommend soaking the buckle element in 2–3% povidone-iodine solution before placement and rinsing the ocular surface with the same solution after placement.

Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes

BACKGROUND AND OBJECTIVE

To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery.

PATIENTS AND METHODS

Retrospective observational case series. Eyes that underwent SB removal between 2010 and 2016 with greater than 1 year of follow-up were included. Main outcome measures were post-SB removal complications and best-corrected visual acuity (BCVA).

RESULTS

Fifty eyes that underwent SB removal met the inclusion criteria. Indications include exposed SB (54%), infection (26%), diplopia (16%), and recurrent retinal detachment (4%). Mean and median intervals between SB placement and removal were 65 months and 30 months. Complications include recurrent retinal detachment (12%), transient ocular hypertension (6%), and persistent diplopia (4%). There was no significant change in mean BCVA after SB removal (P = .979).

CONCLUSIONS

Exposed SB, infection, and diplopia are the most common indications for SB removal. The single-surgery success rate is high and the risk for complications is relatively low. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:138-144.].

Scleral Buckle Infection Caused by Mycobacterium chelonae: A Case Report

A 63-year-old female with a history of retinal detachment repair with scleral buckle from 28 years prior presented with exposure of the buckle in her right eye. After removing the buckle and anchoring sutures, the operation field was washed with 0.25% polyvinyl alcohol-iodine, vancomycin, and ceftazidime. Cultures revealed Mycobacterium chelonae. Systemic meropenem was discontinued on postoperative day 5. The retina remained attached, and there was no recurrence over a 1-year follow-up. We report a case of NTM buckle infection that responded well to thorough washings with polyvinyl alcohol-iodine and antibiotic solutions instead of using a prolonged course of systemic antibiotics.

Incidence of Clinically Significant Aniseikonia Following Encircling Scleral Buckle Surgery: An Evaluation of Refractive and Axial Length Changes Requiring Intervention

To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61; 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.

Recurrence of Retinal Detachment after Scleral Buckle Removal

Purpose

To investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.

Methods

In this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.

Results

Forty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).

Conclusions

Scleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.

Novel Histopathologic and Immunohistochemical Observations in Explanted Orbital Peri-implant Capsules

PURPOSE

To describe the histopathologic and immunohistochemical characteristics of peri-orbital implant capsule and correlate the observed changes with delayed implant extrusion.

MATERIALS AND METHODS

Prospective, ex-vivo, histopathologic, immunohistochemical study of peri-implant capsules excised from capsules surrounding a poly-methyl metha acrylate (PMMA) implant. Thirteen capsules were harvested and divided into two groups. Group 1 (implant extrusion group) consisted of capsules harvested from around exposed/extruded implants and Group 2 (implant non-extrusion group) from implants that were surgically exchanged for volume augmentation. Data collected included demography, clinical presentations, etiology of the explantation, age of the capsule in months, inflammatory cells noted/high power field (HPF), CD3, CD20, and CD68, percentage Masson's trichrome staining and mean capsular thickness.

RESULTS

Mean patient age at presentation was 33 ± 13 years. Of the 13 capsules included, 7 belonged to group 1and 6 to group 2. Mean age of the fibro-collagenous membranes were 33 ± 57 months (median 13 months). Median CD3, CD20, and CD68 positivity was 80%, 9%, and 7% denoting a predominant T-lymphocytic response. Mean capsular thickness was 733 ± 422µ (median 678µ). Age of the harvested capsule showed a linear correlation with inflammatory cells/HPF (r = 0.93, p < .0001, 95% C.I. 0.73 to 0.98), with CD3 positivity (r = 0.6, p = .04, 95% C.I. 0.02 to 0.9), with capillary proliferation/HPF (r = 0.85, p = .003, 95% C.I. 0.43 to 0.96) and with percentage of cells showing Masson's trichrome stain positivity (r = 0.71, p = .03, 95% C.I. 0.08 to 0.93). In the extrusion group, the capsules demonstrated high inflammation and low fibrosis.

CONCLUSIONS

PMMA orbital spherical implant incites a predominantly T-cell mediated inflammatory response which clinically presents as a peri-implant capsule. Increasing inflammation in the absence of significant fibrosis may be responsible for delayed PMMA implant exposure and extrusion.

Lateral Rectus Muscle Tendon Elongation by an Auto Graft from the Resected Medial Rectus Muscle as a Monocular Surgery for Large-Angle Sensory Exotropia

PURPOSE

To evaluate using the resected medial rectus muscle for elongation of the lateral rectus tendon in monocular surgery for large-angle sensory exotropia.

PATIENTS AND METHODS

A prospective case series was carried out in Tanta University hospital from January 2017 to June 2018 including 16 patients with large-angle sensory exotropia ≥50PD. The near and distance angles of exotropia were measured; any restrictions in adduction or abduction were recorded and scaled from -4 to 0. Resection of the medial rectus muscle was done first; the resected segment was attached to the lateral rectus muscle after dissection by mattress sutures, and the muscle was recessed after elongation according to the preoperative distance angles. Successful motor alignment was considered if the angle measurement was within 10 PD of orthotropia at distance after 6 months. The stability of the alignment, any motility restrictions, and patient satisfaction were recorded at each follow-up visit until the 6th month.

RESULTS

The mean age of the study patients was 30.68±13.30 years. The best-corrected visual acuity of the exotropic eyes by logMAR was 1.2±0.3; the mean of the preoperative distance angle of deviation was -72.19 ±14.26 PD. The mean preoperative adduction and abduction restrictions were -1.19 ±1.52 and -1.13 ±1.09, respectively. There was significant improvement in the distance angle of deviation at the last follow-up after 6 months (p=0.001*). Also, there was improvement in both adduction and abduction restriction from the first to last follow-up. Thirteen patients (81.2%) were satisfied at the 6-month follow-up.

CONCLUSION

Elongation of the lateral rectus muscle by an autograft from the resected medial rectus muscle is an easy, effective procedure for large-angle sensory exotropia. Patients achieve good postoperative alignment with minimal restriction of ocular motility.

Infectious conjunctivitis caused by Pseudomonas a eruginosa in infected and extrused scleral buckles

Extrusion of the scleral buckle is one of the complications patients may encounter undergoing the surgical treatment for retinal detachment. We present two cases of persistent Pseudomonas a eruginosa-related conjunctivitis which infected the silicone explant after retinal surgery. One of them is a 73-year-old Caucasian female patient with hyperaemia, intense pain and mucopurulent discharge. After the conjunctival swabs detected a P. aeruginosa infection, she started both topical and systemic treatment without any results; for this reason we opted for the buckle removal always under systemic therapy. The second case is an 84-year-old Caucasian female patient with fever, periorbital oedema, chronic ocular pain, hyperaemia and purulent discharge. P. aeruginosa has also been detected in this case. No improvement with topical and systemic treatment, so this convinced us to remove patient's buckles and to continue systemic therapy. Both cases had the complete resolution after surgery. It is important to quickly recognise exposed scleral buckles because they can be a source of infections and a rare but threatening cause of endophthalmitis.

Fulminant scleral abscess secondary to infected scleral buckle with Moraxella species

We here report a case of scleral buckle infection with fulminant scleral abscess secondary to Moraxella species. A 54-year-old chronic alcoholic male with a history of retinal detachment repair, with scleral buckle 8 years prior, presented with complaints of severe pain, redness, and swelling in the right eye since 2 weeks. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed Moraxella species. The postoperative course included fulminant scleral abscess treated with dual antibiotic therapy that included ceftriaxone and moxifloxacin. All systemic antibiotics were discontinued after 3 weeks, retina remained attached, and no recurrence occurred over a 1-year follow-up. Moraxella, though commonly associated with bacterial keratitis, can also lead to buckle infection, especially in chronic alcoholic and immunocompromised patients. In buckle infection, infected buckle along with sutures should be immediately removed without damaging underlying compromised sclera. Lastly, culture and drug sensitivity play a very important role in buckle infections.

Microbiological profile and antibiotic susceptibility of scleral buckle infections in North India

Purpose:

The aim of this article to study causative organisms for scleral buckle (SB) infections in North India.

Methods:

A retrospective review of records was done for all patients who have undergone SB removal at our institute between January 2009 and December 2017. The records were analyzed for etiological agent of the infected buckle and its antibiotic sensitivity.

Results:

A total of 43 samples were analyzed and a positive culture was noted in 35 (81.40%) cases. The buckle infection rate at our institute was noted to be 2.53%. The commonest organism causing SB infections was Staphylococcus – 15 (42.6%) cases, followed by Pseudomonas – 6 (17.14%) cases and Fungi – 6 (17.14%) cases. The median interval between retinal detachment surgery and buckle explantation was 3 years.

Conclusion:

A large variety of organisms may cause SB infections. The commonest organism found to cause buckle infections in our study was Staphylococcus sp.

Early Buckle Migration and Restrictive Strabismus after Successful Medical Management of Scleral Buckle Infection

We report a case of restrictive strabismus caused by early scleral buckle (SB) migration within 1 month of surgery after successful medical management of SB infection. A 24 year-old man underwent scleral buckling surgery for left eye inferior retinal detachment (RD). A solid silicone buckle element was placed inferiorly along with an encircling silicone band. Two days after surgery, he presented with SB infection. Methicillin resistant Staphylococcus aureus was cultured from the exudate at conjunctival suture sites. Since the retina was well attached and it was only the second postoperative day, it was decided to retain the buckle. SB infection was treated with intravenous cefotaxime and topical fortified cefazolin and successfully eradicated. One month thereafter, anterior SB migration was noted on slit lamp biomicroscopy. Restrictive strabismus and diplopia were also noted. Eventually, SB removal was performed at 2 months. This case report highlights the role of infection and subsequent inflammation as a cause for buckle migration and restrictive strabismus in the early post-operative period. These changes can be seen as early as 1 month after primary surgery and may occur even after successful medical management of the SB infection.

Electrophysiological evaluation of a chronically implanted electrode for suprachoroidal transretinal stimulation in rabbit eyes

In this study, we aimed to determine the electrophysiological efficacy, safety, and electrical stability of a chronically implanted electrode for suprachoroidal transretinal stimulation (STS) in rabbit eyes. A platinum microelectrode was implanted into the scleral pocket of rabbit eyes (n = 5) and followed-up for 6 months. To evaluate the electrophysiological efficacy, electrically evoked potentials (EEPs) were measured every month after implantation. To evaluate safety, fundus examinations, fluorescein angiograms, electroretinograms (ERGs), and visually evoked potentials (VEPs) were measured before and every month after the implantation. At the end of the experiment, histological examination of retinal tissue beneath the site of the electrode was performed. To evaluate electrical stability, the resistance of the circuit was measured every month after implantation. EEPs could be elicited from the STS electrodes at all testing times. The mean threshold current to evoke EEPs was 186.4 ± 47.0 µA at 6 months after implantation. There was no significant change in the threshold over the follow-up period. The resistance of the circuit was significantly increased at 1 months after implantation, with no further increase at 6 months. There was no statistically significant change in the relative amplitudes and implicit times of a- and b-waves of ERGs and VEPs. No intraocular infection, inflammation, or vitreoretinal proliferation was observed in any eye. Histological examination revealed no retinal damage beneath the electrode. We conclude that chronically implanted electrodes for STS appear to be effective, safe, and electrically stable.

The evaluation of ocular refractive error and axial length changes after scleral buckle removal

Purpose:

The present study aimed to evaluate refractive error and axial length changes after buckle removal due to buckle complications.

Methods:

A total of 15 patients involved in this study. The enrolled patients who had history of scleral buckling (SB) for rhegmatogenous retinal detachment referred to clinic for buckle removal due to buckle-related complications. Complete ophthalmic examinations and IOLMaster (Carl Zeiss) device performed prior and 3 months after buckle removal. Also best corrected visual acuity (BCVA), refractive error and axial length changes evaluated after buckle removal.

Results:

BCVA, refractive error, and axial length changes were not statistically significant (P value: 0.24, 0.23, 0.33, respectively). No redetachment or any other complication was observed after buckle removal.

Conclusion:

The study displayed induced globe shape changes due to SB are irreversible after buckle removal. In addition, it is a safe procedure and does not raise any risk of retinal redetachment.

Ocular movement disorders following scleral buckling surgery: A case series study

Purpose

To evaluate ocular movement disorders after scleral buckling surgery (SBS) for retinal detachment.

Methods

In this prospective, observational, case series, 206 patients (206 eyes) with rhegmatogenous retinal detachment who underwent SBS and investigated at the strabismus ward of Farabi Eye Hospital in Iran between November 2011 and November 2014 were assessed. Patients were followed from 6 to 36 months after SBS to evaluate for strabismus. Logistic regression analysis test and SPSS software version 20 were used for statistical analysis.

Results

From 206 patients, 56.8% were male, and 33.2% were female. For scleral buckle in 44.7% of patients, silicone band and tire (SBT) was used, and in 55.3%, a sponge. Among all patients, seven (3.39%) exhibited ocular movement disorder. There was no significant relation between type of buckle (P = 0.65) or the location of buckle (P = 0.56) and movement disorder.

Conclusion

Ocular movement disorder is one of the main complications after SBS without specific association between the type and location of exoplanet.

Multi-drug resistant Mycobacterium chelonae scleral buckle infection

Purpose

To describe a case of Multi-drug resistant Mycobacterium chelonae scleral buckle infection.

Observations

A 56 year-old male with history of retinal detachment repair with scleral buckle 20 years prior presented with 8 months of intermittent pain and redness in the left eye. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed multi-drug resistant Mycobacterium chelonae. The postoperative course included orbital cellulitis treated with systemic linezolid, clarithromycin, and imipenem. All systemic antibiotics were discontinued on post-operative day 25, visual acuity improved to 20/25, the retina remained attached, and no recurrence occurred over 3 years of follow-up.

Conclusions and importance

NTM infections are typically chronic and often require lengthy treatment. SB infection is rare, but often associated with biofilm and antibiotic resistance. In spite of removing the SB, anchoring sutures, sheath surrounding the buckle and associated biofilm, a prolonged course of systemic antibiotics may be necessary in some patients.

Development of Surgical Management in Primary Rhegmatogenous Retinal Detachment Treatment from 2009 to 2015

PURPOSE

To evaluate the evolution of surgical methods over a 7-year period in patients with primary rhegmatogenous retinal detachment (RRD) and its relation to functional outcome and intra- and postoperative complications.

METHODS

This prospective observational study included 628 patients with primary RRD who underwent surgical repair between January 2009 and December 2015. The main outcome measures were the type of surgical procedure ((scleral buckle (SB), pars plana vitrectomy (PPV), combination of SB and PPV or cryocoagulation (CC)) and intraocular tamponades. In addition, functional outcome and intra/postoperative complications were assessed over the observational period.

RESULTS

During the 7-year observation, the percent of SB procedures decreased from 40.5% in 2009 to 2.7% in 2014, while PPV increased from 38% in 2009 to above 90% in 2014. In 2015, the SB procedure was performed in 10.3% and PPV in 85.6% of patients with RRD (p < 0.001). No consistent trend was observed for the use of intraocular gas tamponade. The functional outcome within the 7-year observation ranged from 0.25 ± 0.31logmar in 2012 to 0.42 ± 0.40logmar in 2009 and showed no statistically significant trend (p = 0.28). Intraoperative complications did not change between 2009 and 2015. The rate of cataract surgery and epiretinal membrane development did not change (p = 0.27; p = 0.09). The percent of re-detachment ranged from 6.2 to 16.5% within the observational period (p = 0.14).

CONCLUSION

A shift toward PPV alone for primary RRD repair was observed during the 7-year observation. No decrease in functional outcome or increase of intra- and postoperative complications or decrease of primary and final anatomic success rate was observed following the change in surgical procedure.

Pericardial patch graft repair of severe localized scleral thinning encountered during strabismus surgery

This article presents a surgical technique using a pericardial patch for the permanent repair of severe scleral thinning encountered during strabismus surgery. In the present case scleral thinning resulted from buckle removal. Familiarity with this technique may prove important for the strabismus surgeon treating patients with a history of surface ocular hardware or disease-induced scleral thinning. This video article may be viewed atjaapos.org.

Circumferential silicone sponge scleral buckling induced axial length changes: case series and comparison to literature

Background

This study compared axial length changes induced by circumferential scleral buckling using a silicone sponge with literature reports for solid silicone rubber.

Methods

Records of patients treated with scleral buckling in 2009–2013 using a silicone sponge, with preoperative axial length biometry measurements were reviewed. Additional information included age, type of surgery, additional surgeries, phakic status and anatomical success of reattachment. Patients underwent repeat biometry. The medical literature was reviewed for articles describing axial length changes induced by circumferential buckling using solid silicone rubber.

Results

Twenty-eight patients (mean age 49.7 years, range 16–72) met the inclusion criteria. Mean axial length was 25.38 mm preoperatively and 26.12 mm at least 6 months postoperatively (SD 0.50 ± 0.09, p < 0.001); a mean increase of 0.74 mm. Half the patients subsequently underwent cataract surgery. Post-operative changes were not significant compared to pre-surgical refraction and corneal astigmatism. Axial length change was not significant between sexes (9 women and 19 men).

Conclusions

Axial length changes induced by circumferential scleral buckling using silicone sponge exclusively are similar to those reported in the literature for solid silicone rubber buckles. Scleral buckling using a silicone sponge, which may offer several surgical advantages, induces an acceptable axial length change similar to that seen with widely-used solid silicone rubber buckles.

Scleral buckle infection by Serratia species

We describe a rare case of scleral buckle (SB) infection with Serratia species. A 48-year-old male with a history of retinal detachment repair with scleral buckling presented with redness, pain, and purulent discharge in the left eye for 4 days. Conjunctival erosion with exposure of the SB and scleral thinning was noted. The SB was removed and sent for culture. Blood and chocolate agar grew Gram-negative rod-shaped bacillus identified as Serratia marcescens. On the basis of the susceptibility test results, the patient was treated with oral and topical antibiotics. After 6 weeks of the treatment, his infection resolved.

Ocular infection with Gliocladium species-report of a case

PURPOSE

The purpose of this study is to report a case of ocular infection with Gliocladium species due to an exposed scleral buckle.

DESIGN

Interventional case report was used as the study design.

METHODS

A 60-year-old diabetic male patient presented with persistent pain, redness, and discharge in his left eye since 2 months. He had been treated previously with both topical and systemic steroids for a diagnosis of autoimmune scleritis. He had undergone scleral buckling surgery with cryotherapy for an inferior rhegmatogenous retinal detachment in the past. His best-corrected visual acuity was 6/6, N6 and 6/6, N6 in the right and left eyes, respectively. Retraction of the left lower lid revealed an exposed scleral buckle with an overlying necrotic conjunctiva. Scleral buckle removal was done. Microbiological examination showed Gliocladium species growing on blood agar and Sabouraud dextrose agar. Treatment was started with topical antifungal medication and oral antibiotics.

RESULTS

Following treatment, signs of infection showed resolution. Patient underwent retinal reattachment surgery with favorable anatomic and visual outcome.

CONCLUSION

Ocular infection with Gliocladium species has not been previously reported. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the scleral buckle, identification of the causative organism, and use of appropriate antibiotics are important for the accurate management of the case.

Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure

Purpose

To assess the outcome of sutureless encirlcing number 41 band and transscleral laser retinopexy in uncomplicated rhegmatogenous retinal detachment (RRD), using a wide-angle viewing system (WAVS) and chandelier endoillumination.

Methods

Prospective intervention study included 30 eyes of 30 patients presenting with RRD of recent onset indicated for SB. All cases were treated by sutureless encircling number 41 band and transscleral laser retinopexy. Visualization was provided by the Resight WAVS and a single 27-gauge chandelier endoillumination. Anatomical and visual outcomes were evaluated.

Results

The mean age of our group was 49.8 ± 12.3 years, and the mean duration of RD was 7 (0–50) days. Twenty-four eyes (80.0%) were phakic while the remaining 6 eyes (20%) were either pseudophakic or aphakic. The primary retinal reattachment rate was 83.3% (25 out of 30 eyes). LogMAR visual acuity improved from 1.3 (0.30–2.0) preoperatively to 1.0 (0.40–1.60) at first month (p = 0.002) and to 0.70 (0.20–1.92) at third month (p < 0.001).

Conclusion

Sutureless encircling number 41 band with chandelier-assisted transscleral laser retinopexy is a safe and effective technique for managing uncomplicated RRD. It provides a high primary success rate while eliminating the complications of cryotherapy, sutures, and broad buckles.

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment

Purpose:

To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).

Design:

Retrospective interventional case series.

Materials and Methods:

Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013.

Results:

Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.

Conclusion:

Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Catheter-guided suprachoroidal buckling of rhegmatogenous retinal detachments secondary to peripheral retinal breaks

PURPOSE

To evaluate functional and anatomic outcomes of eyes undergoing suprachoroidal buckling (SCB) using a specially designed catheter for the management of rhegmatogenous retinal detachment (RRD) secondary to peripheral retinal breaks.

METHODS

Retrospective cohort study of 62 eyes of 62 patients. Subjects underwent SCB for the management of RRD secondary to single or multiple retinal breaks. Suprachoroidal indentation was achieved through the introduction of viscoelastic material in the suprachoroidal space overlying the break using an illuminated, 450 μm-wide, flex-tip catheter. This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition. Forty-seven eyes (80 %) underwent SCB alone, while 15 eyes (20 %) were combined with 25-G pars-plana vitrectomy. Cryopexy and laserpexy were used in 38 (61 %) and 24 of eyes (39 %) respectively.

RESULTS

Mean pre-operative best-corrected visual acuity (BCVA) improved from logMAR 0.82 (20/132) to 0.22 (20/33) (p < 0.0001). The single surgery reattachment rate was 92 % (57/62.) Final retinal reattachment was achieved in all eyes (100 %). No significant difference was observed in single-surgery anatomic success rates when stratified by lens status, macular involvement, or break location. There were no major intra- or post-operative complications.

CONCLUSION

Suprachoroidal buckling using a special-design, flexible catheter is a safe and effective procedure for the management of RRD secondary to peripheral retinal breaks.

Small-Gauge Pars Plana Vitrectomy With SF6 Gas for the Repair of Primary Rhegmatogenous Retinal Detachment With Multiple Breaks

BACKGROUND AND OBJECTIVE

To compare outcomes of 25-gauge pars plana vitrectomy (PPV) and sulfur hexafluoride (SF6) gas for primary rhegmatogenous retinal detachment (RRD) associated with multiple-quadrant versus single-quadrant breaks.

PATIENTS AND METHODS

A retrospective study of patients with RRD who underwent 25-gauge PPV with breaks involving multiple quadrants (Group A) or versus a single quadrant (Group B).

RESULTS

One hundred eighteen eyes of 118 patients with a mean age of 60.4 years ± 11.8 years were reviewed, 27 with multiple-quadrant breaks and 91 with single-quadrant breaks. Single surgery anatomical success was achieved in 92.6% of Group A versus 93.4% of Group B patients (P = .88). The location and number of quadrants did not account for the variation in single surgery success or visual outcome.

CONCLUSIONS

RRD with multiple-quadrant breaks is not associated with worst outcomes than single-quadrant breaks when treated with 25-gauge PPV and SF6 gas. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:820-827.].

Indications and outcomes of scleral buckle removal in a tertiary eye care center in South India

Purpose:

To study the clinical profile of patients undergoing scleral buckle removal (SBR) surgery.

Materials and Methods:

All consecutive patients undergoing SBR surgery following scleral buckle for retinal detachment repair between January 2002 and December 2011 with a minimum postSBR follow-up of 6 months were included in this study. A record based on analysis of indications, methods, complications, and outcomes of the eyes was performed.

Results:

One hundred and two eyes of 101 patients (men = 77; 76.24% and women = 24; 23.76%) belonging to the age group of 15–78 years (mean 50 ± 15 years) were included in this study. Time gap between scleral buckle and SBR ranged from 2 to 216 months (mean 61 ± 51 months). Buckle exposure with clinical infection (81; 79.41%) was the most common indication. Of 90 (88.2%) eyes with positive culture, 75 (83.3%) revealed single and 15 (16.6%) revealed multiple microorganisms. Staphylococcus epidermidis (42; 41.2%), was the most common isolate. Fungus was isolated in 3 (2.94%) eyes. Globe perforation (14; 13.7%) and recurrent retinal detachment (7; 6.9%) were the commonest complications. Time gap between SBR and recurrent retinal detachment ranged from 15 days to 50 months (mean 12.2 ± 18.3 months).

Conclusions:

Most of the exposed scleral buckles developed clinical infection few months to years after surgery, ultimately requiring SBR. Recurrent retinal detachment after SBR may appear from few days to years later warranting a long-term follow-up.

Clinical-Radiological Correlation of Retained Silicone Sponge Presenting as Orbital Inflammation

A 32-year-old female who underwent scleral buckle removal presented 5 weeks postoperatively with a red, fluctuant subconjunctival mass. CT scan identified an irregularly bordered, hypoattenuated lesion next to the globe with the density of air. Ophthalmic plastic and reconstructive surgeons were consulted to evaluate orbital cellulitis with intraorbital gas, at which point it was deemed that the hypoattenuated mass was likely a retained sponge element based on its radiological features. Additional surgical exploration identified the retained silicone sponge. This clinical photographic-radiological correlation of retained silicone sponges presenting as orbital inflammation reminds surgeons to meticulously explant buckle material.

Tendon elongation with bovine pericardium (Tutopatch®) when conventional strabismus surgery is not possible

PURPOSE

Sometimes, a conventional recess-resect surgery may not be sufficient to obtain satisfactory ocular alignment. Patients who have previously undergone surgery and/or have a large difference in visual acuity between both eyes and do not wish to undergo surgery on the sound eye provide a surgical challenge. In these cases, tendon elongation with bovine pericardium may be an option.

METHODS

We retrospectively reviewed the charts of 38 patients who underwent strabismus surgery with tendon elongation. Before surgery, 31 had exotropia (angle -21.8 ± 5.7 degrees) and 7 esotropia (angle +19.1 ± 5.4 degrees). Reasons for tendon elongation included the following: 15 patients refused surgery on their sound eye; in 15 patients, conventional recess-resect was not possible; and in 7 patients, the elongation best fitted the motility pattern. In one patient, tendon elongation was preferred over conventional recession because of a thin sclera. Follow-up was 0.5 to 4 years.

RESULTS

At last follow-up visit, in patients with previous exotropia, the angle was -3.3 ± 5.9 degrees; in patients with previous esotropia, +0.2 ± 0.5 degrees. Most had some duction limitation in the direction of the elongated muscle. All patients but one were satisfied with the result. In the patients with previous exotropia, there was a small but nonsignificant regression to recurrence of the exodeviation (on average 0.5 degree per year).

CONCLUSIONS

Tendon elongation is a valuable addition to our strabismus surgery repertoire. However, because of duction limitations after surgery, it should be reserved for those cases in which conventional surgery is not an option.

Methicillin-resistant Staphylococcus aureus buckle infection complicated by endophthalmitis and presumed choroidal abscess in a patient with ulcerative colitis

This patient presented with excessive pain, lid swelling, erythema, heat and limitations of extraocular movement (OD) nine days after a scleral buckle (SB) and pneumopexy surgery. Complicated buckle infection with endophthalmitis was impressed. Bacterial culture yielded methicillin-resistant Staphylococcus aureus. A choroidal abscess was identified 1 week after the episode. Complete visual recovery from hand motion to 20/30 (OD) was achieved with buckle removal, subconjunctival and intravitreal antibiotics. Endophthalmitis and choroidal abscess formation after SB surgery is extremely rare. Host factors including ulcerative colitis may play a role in causing the severe buckle infection of this patient.

Retinal Detachment Due to Retinal Dialysis: Surgical Outcome After Scleral Buckling

PURPOSE

The aim of this study was to determine the efficacy and safety of scleral buckling surgery in retinal detachment due to retinal dialysis.

DESIGN

This study was a prospective, interventional case series.

METHODS

A total of 48 eyes of 48 consecutive patients were included after obtaining informed written consent. Besides taking a thorough history, all eyes were examined by a retinal surgeon. The macula status, site, and extent of retinal dialysis and rhegmatogenous retinal detachment (RRD) were particularly noted. Proliferative vitreoretinopathy grading was done. Buckling was performed by a single surgeon. At every follow-up, visual acuity, intraocular pressure, retina status, and buckle position were noted. Any complication found was recorded. Follow-up was done for at least 6 months. SPSS version 16 was used for data analysis.

RESULTS

We included 48 cases of RRD due to retinal dialysis. The mean ± SD age of the patients was 26.85 ± 15.1 years. The macula was detached in 85.4% of the cases, and proliferative vitreoretinopathy grade C was found in 25% of the cases. A surgical reattachment rate of 95.8% was attained after a single primary buckling procedure. Final Snellen best-corrected visual acuity of 6/18 or better was attained in 12.5% of the cases. However, 62.5% of the cases had best-corrected visual acuity in the range of 6/24 to 6/60. Subretinal hemorrhage occurred in 8.3% of cases intraoperatively after subretinal fluid drainage.

CONCLUSIONS

We conclude that scleral buckling has a definite role in the management of RRD due to retinal dialysis.

An epibulbar chocolate cyst: a rare complication of silicone-based scleral buckle

A patient with a history of vitreoretinal surgery presented with nasal dystopia, diplopia and epibulbar bluish black mass simulating a chocolate cyst in the right eye. After a non-conclusive ocular examination, he underwent CT of the orbit along with volume rendition and three-dimensional reconstruction, which demonstrated intact globe with laterally displaced band-buckle assembly along with peri-scleral buckle element (SBE) soft tissue proliferation. Imaging-assisted exploration of the lesion was performed and retained scleral buckle element (SBE) was removed in toto; thus relieving the patient long-standing dystopia.

Surgical complications of primary rhegmatogenous retinal detachment: a meta-analysis

BACKGROUND

To investigate the surgical complications of scleral buckling (SB) and pars plana vitrectomy (PPV) performed on primary rhegmatogenous retinal detachment (RRD) and to discover which surgical procedures bring fewer complications.

METHODS

An electronic literature search using the PubMed database, ISI Web of Knowledge and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and observational studies comparing SB with PPV on primary RRD. Outcome measures included intra-operative complications and early and late post-operative complications.

RESULTS

During the operation, significantly less subretinal hemorrhage occurred in the PPV group than in the SB group (OR = 4.71; 95%CI, 1.33-16.64; p = 0.02) and the hypotony incidence was significantly higher in the SB group (OR = 18.24; 95%CI, 2.37-140.44; p = 0.005); however, the occurrence of iatrogenic breaks was significantly lower in the SB group (OR = 0.05; 95%CI, 0.01-0.21; p<0.0001). In the early stage of post-operation, significantly higher incidence of choroidal detachment was identified in the SB group than in the PPV group (OR = 10.19; 95%CI, 2.36-44.09; p = 0.002); patients undergoing SB had significantly higher odds of residual subretinal fluid (OR = 14.71; 95%CI, 1.84-117.32; p = 0.01); the occurrence of high intraocular pressure was significantly lower in the SB group (OR = 0.46; 95%CI, 0.23-0.89; p = 0.02); and no significant difference was shown in the incidence of epithelia defect (p = 0.37) between the two groups. In the late stage of post-operation, the incidence of diplopia/extraocular muscle dysfunction was significantly higher in the SB group (OR = 4.04; 95%CI, 1.30-12.52; p = 0.02); and significantly less cataract was observed in the SB group (OR = 0.20; 95%CI, 0.14-0.30; p<0.00001); no significant difference was found in the incidences of cystoid macular edema (p = 0.65), macular pucker (p = 0.52), post-operative proliferative vitreoretinopathy (p = 0.73) and epiretinal membrane (p = 0.47) in other late post-operative complications.

CONCLUSIONS

This meta-analysis suggests that PPV could be considered as potential surgical management on primary RRD.

INNOVATIVE MULTIPLANAR RECONSTRUCTION AND VOLUME-RENDERED COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF SCLERAL BUCKLE-RELATED COMPLICATIONS

PURPOSE

To describe the role of multiplanar reconstruction and three-dimensional volume-rendered imaging in the assessment of silicon-based scleral buckle (SB)-related complications.

METHODS

Five eyes of five patients with SB-related complications where the history, surgical notes, and clinical examination proved inconclusive were included. Unenhanced axial orbital computed tomography images of all patients were acquired parallel to orbitomeatal line, and images were reviewed in orthogonal planes. The volume rendition of the imaged volume was evaluated in various tilts, with special reference to the spatial relationship of the band-buckle to the globe and bony orbit. All patients underwent imaging-assisted SB removal.

RESULTS

Imaging assisted in in vivo localization of the obscure band or buckle in all five eyes. Band was seen as hyperdense structure encircling whole of the globe, whereas buckle was seen as segmental, broad, hyperdense structure with scleral indentation. Presence of SB was identified in three patients, and globe integrity was shown in the other two. Abnormal anterior displacement of band and buckle was demonstrated in three cases on volume-rendered imaging in relation to lateral orbital rim. Focal exuberant soft-tissue proliferation around the buckle was present in all patients, suggesting chronic inflammation and infection. Successful removal of band and buckle could be achieved, and all patients were relieved of their preoperative complaints. No complication occurred during intraoperative and postoperative period.

CONCLUSION

Use of multiplanar reconstruction and three-dimensional volume-rendered computed tomography imaging played a pivotal role in surgical success.

Implantable MicroPump for Drug Delivery in Patients with Diabetic Macular Edema

PURPOSE

To demonstrate the safety and surgical feasibility of the first-in-man ocular implant of a novel Posterior MicroPump Drug Delivery System (PMP) in patients with diabetic macular edema (DME) and to report on the device capabilities for delivering a programmable microdose.

METHODS

This was a single center, single arm, open-label, prospective study. Eleven patients with DME and visual acuity equal to or worse than 20/40 were included. The PMP prefilled with ranibizumab was implanted into the subconjunctival space. After implantation, the PMP was wirelessly controlled to deliver a programmed microdose. Comprehensive ophthalmic exams and optical coherence tomography were performed biweekly for 90 days. At the end of the study, the PMP was explanted and the subjects thereafter received standard of care for DME (i.e., laser or intravitreal injections).

RESULTS

All 11 surgical implantations were without complications and within the skill sets of a retinal surgeon. No serious adverse events occurred during the follow-up period. At no point were visual acuity and central foveal thickness worse than baseline in the implanted eye. The PMP delivered the programmed ranibizumab dosage in seven subjects. The remaining four patients received a lower than target dose, and the treatment was complemented with standard intravitreal injection.

CONCLUSIONS

This study demonstrates the first-in-man safety of the Replenish MicroPump implant for a period of 90 days and its capability to deliver a microdose into the vitreous cavity. Further studies to enable longer-term safety and to demonstrate the feasibility of multiple programmable drug delivery are necessary.