Erosion and intrusion of silicone rubber scleral buckle. Presentation and management

Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber

Purpose

To report anterior-segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management.

Methods

This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit-lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach.

Results

The mean age of patients was 28.2 (7-53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post-operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub-acute, and four had chronic presentations. Descemet's membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit-lamp, one via an external approach, two via an internal approach, and three via a combined approach.

Conclusion

ASOCT facilitates non-invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC FBs.

Sustained release of brimonidine from BRI@SR@TPU implant for treatment of glaucoma

Glaucoma is the leading cause of irreversible vision loss worldwide, and reduction of intraocular pressure (IOP) is the only factor that can be interfered to delay disease progression. As the first line and preferred method to treat glaucoma, eye drops have many shortcomings, such as low bioavailability, poor patient compliance, and unsustainable therapeutic effect. In this study, a highly efficient brimonidine (BRI) silicone rubber implant (BRI@SR@TPU implant) has been designed, prepared, characterized, and administrated for sustained relief of IOP to treat glaucoma. The in vitro BRI release from BRI@SR@TPU implants shows a sustainable release profile for up to 35 d, with decreased burst release and increased immediate drug concentration. The carrier materials are not cytotoxic to human corneal epithelial cells and conjunctival epithelial cells, and show good biocompatibility, which can be safely administrated into rabbit’s conjunctival sac. The BRI@SR@TPU implant sustainably released BRI and effectively reduced IOP for 18 d (72 times) compared to the commercial BRI eye drops (6 h). The BRI@SR@TPU implant is thus a promising noninvasive platform product for long-term IOP-reducing in patients with glaucoma and ocular hypertension.

Scleral Buckling: A Review of Clinical Aspects and Current Concepts

Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.

Results of different strategies to manage complicated retinal re-detachment

PURPOSE

Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study's aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed.

METHODS

A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups.

RESULTS

This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3-1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2-1.8). The post-treatment decrease in group 1 was a median equal to - 0.6 versus - 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups.

CONCLUSION

For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO.

Intrusion of episcleral buckles: report of two cases and brief review

Background

The authors report two cases of the scleral buckles intrusion and erosion that presented many years after primary surgery with vitreous haemorrhage in one of them. Although the erosion/intrusion of a silicone scleral buckle (SB) is rare, it may have serious consequences and optimal management can be challenging. Therefore, this diagnosis should be considered if attributable signs and symptoms including vitreous haemorrhage occurred after scleral buckling. The authors briefly review the literature on clinical presentation and management of the episcleral silicone buckling erosion and intrusion.

Case presentation

Case 1: A 48-year-old woman with a history of scleral buckling for an inferior rhegmatogenous retinal detachment presented with visual loss in her right eye. A vitreous haemorrhage was observed. After Close observation, Partial resolution of haemorrhage revealed an intruded sponge segment in inferior vitreous cavity. Case 2: A 26-year-old man was referred for retinal evaluation. Twenty years earlier, he had undergone lensectomy for bilateral childhood cataract. Ten years ago, he had developed an aphakic RRD in the left eye. The detachment was managed with pars plana deep vitrectomy, endolaser, an encircling silicone band, and silicone oil injection. On examination an eroded band was noted.

Conclusion

Although the erosion/intrusion of a silicone episcleral buckle is rare, it may have serious consequences and optimal management can be challenging. Unnecessarily destructive techniques may predispose the eye to this complication and should be avoided. Patients who have a history of SB need lifelong follow-up and this diagnosis should be considered if attributable signs and symptoms occurred.

Ocular hypotony: A comprehensive review

Ocular hypotony is an infrequent, yet potentially vision-threatening, entity. The list of differential causes is extensive, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures. Depending on the cause and the clinical impact, treatment options aim to correct the underlying pathology and to reestablish anatomical integrity, as well as visual function. We review the pathophysiology, clinical presentation, different causes, and associated therapeutic options of ocular hypotony.

Intrusion of Dacron suture knot 15 years after scleral buckling

Background

We present a case of intrusion of a suture knot 15 years after scleral buckling surgery.

Case presentation

A 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15 years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o’clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached.

Conclusions

The suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.

Extrusion and Infection Incidence in Scleral Buckling Surgery with the use of Silicone Sponge: To Soak or not to Soak? An 11-Year Retrospective Analysis

PURPOSE

To assess the incidence of extrusion and infections of encircling silicone sponges in scleral buckling surgery for retinal detachment with and without the use of an intraoperative antibiotic soaking procedure.

METHODS

The authors performed a retrospective analysis reviewing the charts of 1127 patients who underwent episcleral buckling surgery operated by the same surgeon in three different institutions during a period of 11 years. The authors reviewed the charts of patients treated with a single episcleral silicone sponge (Labtician) indentation in three different models. The infection prophylaxis on the operating field was the same in all cases and only since February 1997 was the silicone sponge preoperatively treated with an antibiotic soaking procedure.

RESULTS

No immediate postoperative infections were reported in the operated eyes. Three eyes had an implant extrusion and in all these cases silicone sponge removal was performed. All three extrusion cases developed when sponge soaking was not adopted.

CONCLUSIONS

The data indicate that the soaking procedure does not decrease extrusion and infection incidence in scleral buckling surgery when both accurate surgical technique and disinfection prophylaxis are performed.

Postoperative Complications of Scleral Buckling

Scleral buckling has an important role in the repair of certain categories of rhegmatogenous retinal detachments. These include detachments in young phakic patients, detachments associated with dialysis, and also in conjuction with vitrectomy in patients who have sustained trauma or have developed proliferative vitreoretinopathy. However, it can be associated with significant postoperative complications. The most important ones are refractive change, intrusion or extrusion, infection, globe ischemia, and choroidal detachments, amongst others. Careful planning, appropriate patient selection, and good intraoperative technique can reduce the rate of these complications.

Secondary Glaucoma Associated with Encircling Scleral Buckle Migration into the Cornea

Transmuscular migration of the encircling band through rectus muscles and straddling of the cornea has only been reported in a few cases previously in the literature. This rare condition has never been associated with glaucoma. In this report, we aimed to describe a unique case with transmuscular migration of encircling buckle as a probable cause of glaucoma. A 17-year-old female presented with transmuscular migration of buckle and high intraocular pressure (IOP). Limbal/corneal migration of the silicone band was thought to be the main reason for the IOP rise; therefore, scleral band removal was performed. One month after removal, the patient was free of glaucoma medications and IOP was within normal limits. The retina remained attached during all postoperative visits. Transmuscular migration of the encircling band through rectus muscles and straddling of the cornea may act as a trigger for glaucoma.

MIRAgel: the immunohistochemical expression of CD3, CD34, and CD68 in the surrounding capsule

PurposeTo study the immunohistochemical features of the capsule tissue surrounding MIRAgel episcleral buckles.Patients and methodsThis Institutional interventional clinical cohort study examined a consecutive series of 21 referred patients who required MIRAgel removal from July 2009 to July 2013. All patients with hydrated and fragmented MIRAgel episcleral buckles were included in this study. Capsule biopsies from MIRAgel episcleral buckles were obtained from all patients. Capsule specimens of seven patients with extruded silicone bands were processed as controls. Paraffin-embedded specimens were examined using light microscopy and immunohistochemistry (via the PAP horseradish peroxidase technique) to detect the expression of CD3, CD20, CD34 and CD68, and S-100 protein.ResultsInflammation with granuloma, which was primarily related to sutures, was found in all (n=36) of the MIRAgel specimens and foreign body granulomas with multinucleated giant cells, histiocytes, and macrophages (CD68+ cells) surrounded the MIRAgel fragments. Average number of CD68+ cells was higher (P<0.001) for MIRAgel than for silicone rubber. The lymphocytic inflammatory infiltrate related to the MIRAgel fragments was CD3+ and CD20- (delayed T cell-mediated immune response). Moderate neoangiogenesis was indicated by the presence of CD34+ cells.ConclusionsThe immunohistochemical analysis revealed that the immune system is able to identify the fragments of MIRAgel (after its hydrolytic degradation) as a foreign body during a delayed T cell-mediated immune response. The phagocytosis by macrophages likely triggers and perpetuates local disease. Removal of MIRAgel explants before hydrolysis should be considered.

Retinal detachment caused by Arruga suture scleral intrusion. Treatment

CASE REPORT

We present the case of an 81-year-old man with retinal detachment caused by intrusion of an Arruga suture. The encircling buckle was located in the sub-retinal space and caused retinal breaks with retinal detachment

DISCUSSION

A pars plana vitrectomy was performed along with intraocular cutting of the Arruga suture with retinal re-attachment.

Intraocular intrusion of suture material that was used as scleral buckling material

PURPOSE

To report intrusion of encircling suture used for scleral buckling 20 years ago.

METHODS

Observational case report of a patient who admitted with the complaint of floaters. The patient had surgery for retinal detachment 20 years ago. Fundus examination revealed an encircling suture material. In some locations, the encircling suture had eroded all the way through the sclera to the vitreous cavity. In these locations, it was passing through the vitreous cavity. There was no retinal detachment, inflammation, or hemorrhage.

RESULTS

Prophylactic argon laser photocoagulation was performed. No complication occurred during 1-year follow-up.

CONCLUSION

A conservative approach with close follow-up may be suitable in case of an intrusion of suture material if there are no accompanying complications.

Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility

BACKGROUND

The purpose of the present study was to evaluate the microbiological spectrum and antimicrobial susceptibility in patients with scleral buckle infection. Medical records of all the patients diagnosed as buckle infection at L. V. Prasad Eye Institute between July 1992 and June 2012 were reviewed in this non-comparative, consecutive, retrospective case series.

FINDINGS

A total of 132 eyes of 132 patients underwent buckle explantation for buckle infection during the study period. The incidence of buckle infection at our institute during the study period was 0.2% (31 out of 15,022). A total of 124 isolates were identified from 102 positive cultures. The most common etiological agent isolated was Staphylococcus epidermidis (27/124, 21.77%) followed by Mycobacterium sp. (20/124, 16.13%) and Corynebacterium sp. (13/124, 10.48%). The most common gram negative bacilli identified was Pseudomonas aeruginosa (9/124, 7.26%). The median interval between scleral buckling surgery and onset of symptoms of local infection was 30 days. All eyes underwent buckle explantation and median time interval between primary SB surgery and explantation was 13 months. Recurrent retinal detachment was observed in two cases at 7 and 48 months, respectively, after buckle explantation. Gram positive, gram negative, and acid-fast organisms isolated from 2003 to 2012 were most commonly susceptible to vancomycin (100%), ciprofloxacin (100%), and amikacin (89%). Susceptibility to ciprofloxacin during the same time period was observed in 75% (15/20), 100% (13/13), and 87% (7/8) of gram positive, gram negative, and acid-fast isolates, respectively.

CONCLUSION

Scleral buckle infection is relatively rare and has a delayed clinical presentation. It is most commonly caused by gram positive cocci. Based on the current antimicrobial susceptibility, ciprofloxacin can be used as empirical therapy in the management of scleral buckle infections.

25-gauge pars plana vitrectomy with medium-term postoperative perfluoro-n-octane tamponade for inferior retinal detachment

BACKGROUND AND OBJECTIVE

To describe a series of patients with inferior retinal detachments managed with primary 25-gauge pars plana vitrectomy (PPV), 2 to 3 weeks of postoperative perfluoro-n-octane (MT-PFO) tamponade, and upright positioning followed by secondary PPV and PFO removal.

PATIENTS AND METHODS

Interventional case series of 157 patients with inferior retinal detachments with and without proliferative vitreoretinopathy. Eyes were treated with 25-gauge PPV, endophotocoagulation, and MT-PFO tamponade. Patients underwent postoperative upright positioning followed by repeat PPV and PFO removal in a planned, staged procedure.

RESULTS

Mean follow-up was 32 ± 4.6 months. Successful reattachment was achieved in 87.5% of 159 eyes. Main initial postoperative complications were persistent intraocular pressure (IOP) elevation in 34% (n = 54), excessive inflammation in 27% (n = 43), and PFO in the anterior chamber in 21% (n = 34). Additional complications occurring after PFO removal included cataract surgery in 16% (n = 22) of initially phakic eyes, redetachment in 13% (n = 21), and need for filtering surgery in 6% (n = 10). Logistic regression analysis revealed macula status (P = .003) and progression to filtering surgery (P = .001) as significant factors predicting visual outcome at 1-year follow-up.

CONCLUSION

MT-PFO tamponade and upright head positioning may be efficacious for inferior retinal detachment repair in patients unable to assume face-down postoperative positioning. Anatomic and visual outcomes are similar to previously described reattachment procedures. A characteristic granulomatous inflammatory reaction presents in some patients, but does not appear to leave long-term visual or anatomic sequelae. Persistent IOP elevation and progression to filtering surgery may occur in a small percentage of patients and portends a worse visual outcome.

Delayed scleral buckle infection due to Alternaria species

OBJECTIVE

To report a case of scleral buckle infection by Alternaria fungus.

CASE REPORT

A 75-year-old male who underwent rhegmatogenous retinal detachment repair 11 years ago developed a scleral buckle infection during the course of serial injections of bevacizumab for the treatment of wet age-related macular degeneration. Removal of the scleral buckle was done and culture results revealed Alternaria species.

RESULTS

The infected scleral buckle was removed and the patient received oral voriconazole. The patient's best corrected visual acuity changed from 20/50 preoperatively to 20/150 six months after the procedure.

CONCLUSION

Alternaria species may be encountered as a cause of scleral buckle infection.

Efficacy, safety, and biodegradation of a degradable scleral buckle of chitosan-gelatin polymer in rabbits

PURPOSE

To evaluate the efficacy, safety, and biodegradation of chitosan-gelatin scleral buckles in rabbit eyes.

METHODS

Segmental scleral buckling was performed on the left eye of each rabbit. There were 40 rabbits in chitosan-gelatin group and 20 rabbits in silicone sponge group. B-scan ocular ultrasonography was used to evaluate buckling effect. Retinal function after implantation was evaluated by electroretinograms. Tissue reaction and biocompatibility was examined by histology. Scanning electron microscope was used to analyze structural changes after episcleral implantation. Degradation of chitosan-gelatin was assessed by mass loss.

RESULTS

Indentation of both implants decreased over time. However, the indentation created by chitosan-gelatin implant was lower than the silicone sponge one. Extrusion of implant was found in 20% eyes of silicone sponge group. Electroretinography revealed no detectable difference in retinal function between the two groups. Partially degraded chitosan-gelatin, newly formed capillaries, loose connective tissue, and some cell infiltration were found in chitosan-gelatin; however, only a slight cell infiltration was found in silicone sponge. Over a 9-month observation period, degradation rate of the chitosan-gelatin was about 36%.

CONCLUSION

Chitosan-gelatin polymer was used effectively and safely as an implant for scleral buckling in a rabbit and showed good biodegradation.

A Case of Extrusion of a Solid Silicone Tire Migrating through the Superior Rectus Muscle with Aeromonas hydrophila Infection following a Scleral Buckling Procedure

To our knowledge, there are no reports of Aeromonas hydrophila infection after a scleral buckling procedure. Also, migration of a silicone explant element through the rectus muscles is extremely rare. Herein, we describe a case experiencing extrusion of a solid silicone tire migrating through the superior rectus muscle with Aeromonas hydrophila infection following a scleral buckling procedure. A 42-year-old man was referred to our hospital complaining of ocular pain and purulent discharge in his left eye which has persisted for several months. He had a history of bilateral rhegmatogenous retinal detachment which had been treated with scleral buckling. The left eye showed extrusion of the solid silicone buckle which had migrated through the superior rectus muscle and an infection in the upper quadrant of the sclera. The buckle was removed, and the patient was treated with antibiotics. After the removal of the buckle, the symptoms showed rapid amelioration and there was no recurrence of retinal detachment. Aeromonas hydrophila was isolated from the discharge and the removed explant. He used well water in daily life. In this case, the Aeromonas hydrophila infection of the extruded buckle might have originated from contaminated well water.

Scleral buckle removal: indications and outcomes

Primary scleral buckling has been an effective means to reattach the retina for over 50 years. After surgery, complications may arise that require scleral buckle (SB) removal. The most common indications for SB removal are extrusion, infection, and pain. I review the pertinent literature in an effort to develop guidelines for when to remove a SB.

Simultaneous extrusion and intrusion of a scleral buckle in a patient with Marfan's syndrome

An Asian male in his late 50s with known Marfan's syndrome (MFS) presented with sudden deterioration in vision and loss of globe structure 13 years after the placement of a silicone scleral encircling band for the management of retinal detachment. Surgical exploration revealed simultaneous intrusion and extrusion of the encircling band resulting in globe perforation and collapse. This was managed by removal of the encircling band and a scleral patch graft over the defect. This case highlights that in patients with thin sclera, such as in MFS, scleral perforation is a potential complication that should be considered in patients undergoing scleral buckling. Management of this complication is also technically difficult because of impaired healing of the sclera in these patients.

Scleral buckle extrusion associated with phthisis

Exposure of implanted episcleral element is a rare complication of buckling procedures. We describe a 40-year-old man who presented to our clinic complaining of foreign body sensation and irritation in his left eye which lasted several months. The patient history was positive for bilateral rhegmatogenous retinal detachment which was treated with sclera buckling. Upon presentation the left eye demonstrated phthisis and an exposed and infected sclera buckle and explant in the lower quadrants. The explant was removed, and the patient was treated with antibiotics. This case suggests that wide encircling sclera element might erode through the conjunctiva of eyes undergoing phthisis. Integrity of the conjunctiva overlying episcleral implant should be evaluated during routine follow-up exams to exclude exposure of the implant particularly in eyes undergoing phthisis.

Fabrication and evaluation of chitosan-gelatin based buckling implant for retinal detachment surgery

The traditional nonabsorbable silicone buckling implant (buckle) may cause some long-term complications when it is used in the retinal detachment surgery. In this study we fabricated a chitosan-gelatin based buckling implant to replace the traditional one. We evaluated its biocompatibility with human scleral fibroblasts (HSF) in vitro and its cytotoxicity with L929 cell. To evaluate elasticity and hardness of the blends buckle, the mechanical properties of the chitosan-gelatin buckle were compared with the traditional silicone buckle. The light and electron microscopy coupled with immunocytochemistry demonstrated that chitosan-gelatin blends supported the survival and growth of primarily cultured HSF without significant cytotoxic effects. MTT analysis and cell cycle analysis indicated that chitosan-gelatin blends promoted the proliferation of HSF. A preliminary in vivo implantation test indicated that chitosan-gelatin buckling implant were compatible with the surrounding tissue. The results collectively demonstrated that chitosan-gelatin blends could be a candidate biodegradable material for scleral buckling surgery.

[Reasons for readmission to hospital after vitreoretinal surgery: 5-year retrospective follow-up]

INTRODUCTION

To study the etiologies and occurrence rate of readmissions after vitreoretinal surgery.

PATIENTS AND METHODS

One hundred fifty-three eyes requiring vitreoretinal surgery in 2000 at the Besançon (France) University Hospital were retrospectively studied. The occurrence rate and etiologies of these readmissions and the time between surgery and readmission were analyzed from the patient files.

RESULTS

The main indications for vitreoretinal surgery were retinal detachment, epiretinal membrane surgery, idiopathic macular holes, neovascular retrovascular membranes, and intravitreal hemorrhage. A total of 40.5% of the patients were readmitted. The major causes were redetachment and cataract for retinal detachment surgery and cataract for epiretinal membrane and macular hole surgeries.

CONCLUSION

The results highlight the possibly iatrogenic association between anterior and posterior eye segment surgeries, in agreement with the literature.

Risk factors for scleral buckle removal: a matched, case-control study

PURPOSE

To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal.

DESIGN

Retrospective, consecutive, matched, case-control study.

METHODS

Cases included all patients undergoing SB removal between August 1988 and December 2007 at a single academic center. Cases were matched against four randomly selected control patients who underwent SB implantation during the same year as the case. Odds ratios (OR) were calculated for each factor investigated.

RESULTS

Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, using univariate analysis, included concurrent globe-penetrating injury at time of SB placement (OR, 24; 95% confidence interval [CI], 2.9 to 200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; 95% CI, 4.9 to 61), diabetes mellitus (DM) (OR, 7.3; 95% CI, 1.8 to 30), prior chronic topical ocular therapy (OR, 4.3; 95% CI, 1.7 to 11), and subsequent ocular procedures (OR, 3.4; 95% CI, 1.5 to 7.5). Factors independently associated with SB removal using multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; 95% CI, 1.7 to 426), concurrent PPV (OR, 11.3; 95% CI, 2.9 to 45), DM (OR, 8.9; 95% CI, 1.3 to 58), and subsequent ocular procedures (OR, 3.9; 95% CI, 1.4 to 11). Factors that did not alter SB removal risk included patient age; gender; and type, size, or location of buckling elements used.

CONCLUSIONS

Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.

Transmuscular migration and straddling of the cornea by an encircling buckle

Postoperative complications of scleral buckling surgery are various. The anterior migration through the rectus muscles and positioning in the corneoscleral junction is an atypical and undocumented complication. The authors describe a patient with a migration and straddling of the encircling buckle in the corneoscleral junction 2 years after a classic retinal surgery with an encircling solid silicone buckle. Many predisposing factors can lead to this situation.

Décollements de rétine récidivants après vitrectomie en première intention chez le patient pseudophake

INTRODUCTION

The aim of this study was to evaluate the incidence of pseudophakic retinal detachment (RD) recurrence after primary vitrectomy.

PATIENTS AND METHODS

This was a prospective nonrandomized consecutive case series study, evaluating two series presenting to our clinic with pseudophakic RD from 1998 to 2004 (103 eyes of 97 patients). The study included 24 consecutive pseudophakic eyes treated with gas vitrectomy surgery with placement of an encircling band from January 1998 to December 2000 (group A) and 79 consecutive pseudophakic eyes treated with gas vitrectomy surgery with no encircling band from January 2001 to December 2004 (group B). Pre- and postoperative characteristics were analyzed in both groups. In the cases of postoperative RD recurrence, we particularly analyzed the pre- and postoperative risk factors, as well as the anatomic and functional outcome.

RESULTS

Visual acuity improved in 74/103 (71.8%) eyes from both groups postoperatively. Recurrence of RD after primary vitrectomy occurred in eight of 103 (7.8%) eyes in both groups. More specifically, two of 24 (8.3%) eyes in group A and six of 79 (7.6%) eyes in group B presented a recurrence after gas vitrectomy with encircling band and gas vitrectomy alone, respectively. Among these eight eyes, four eyes (50%) presented proliferative vitreoretinopathy (PVR) at the time of initial vitrectomy, while all eyes presented PVR at the time of recurrence (one grade B, seven grade C). These eyes required two additional interventions on average. Five eyes (62.5%) required silicone-oil tamponade for a good anatomic reapplication.

DISCUSSION

These results show that recurrence after primary vitrectomy for pseudophakic RD is most often related to the presence of PVR before or after the first intervention. This series reports a success rate of 91.7% and 92.4%, respectively, for group A and B, thus demonstrating the efficacy of vitrectomy in the treatment of pseudophakic RD. This study also shows a nonsignificant difference in the recurrence rate among patients treated by gas vitrectomy and those undergoing gas vitrectomy in association with encircling band placement, which raises the question of the usefulness of an additional encircling band in pseudophakic RD.

HISTOLOGIC ANALYSIS OF BIOABSORBABLE SCLERAL BUCKLING IMPLANTS

PURPOSE

To analyze histologically tissue reactions to bioabsorbable PLA96 in rabbit eyes.

METHODS

Scleral buckling operations were carried out in 48 rabbits. Two materials were used: bioabsorbable PLA96 (polylactide 96/4; L/D molar ratio 96/4) and silicone sponge. One eye of each rabbit was operated on and the other eye served as a nonoperated control. After follow-up times of 1, 3, 5, and 12 months, the rabbits were killed and the eyes enucleated for histology.

RESULTS

All rabbits recovered well. Histologically, tissue reactions were very localized; implant fragments were not seen within the sclera. The amounts of fibrous tissue and inflammatory cells (mainly macrophages) inside the implant area increased over time. One rabbit from the silicone group was killed 4 months postoperatively owing to refusal to eat. In the PLA96 group, acute or chronic infections occurred in four rabbits. The bioabsorbable implant was macroscopically easily detectable at 12 months postoperatively.

CONCLUSIONS

The PLA96 material used for scleral buckling in rabbits showed good biocompatibility. The material did not undergo biodegradation during the follow-up period of 12 months. PLA96 implants were associated with thicker fibrous tissue encapsulation and more inflammatory cells compared with silicone sponge implants.

PERSISTENCE OF INDENTATION WITH BIOABSORBABLE POLY-l/d-LACTIDE VERSUS SILICONE SPONGE SCLERAL BUCKLING IMPLANTS

PURPOSE

To measure the amount and duration of indentation depth achieved with biodegradable poly-L/D-lactide 96/4 (PLA96) and silicone sponge implants.

METHODS

Thirty rabbits underwent a scleral buckling procedure. A PLA96 buckling implant was used in 15 rabbits and a silicone sponge buckling implant was in 15 rabbits. A circumferential scleral buckling implant was sutured episclerally on the left eye of each rabbit, just temporal to the superior rectus muscle and 7 mm posterior to the limbus. Computed tomography was performed at 1 week, 3 months, and 5 months after surgery.

RESULTS

The PLA96 buckling implant (implant diameter, 3-3.5 mm) used in this study created lower indentation than the silicone sponge implant (implant diameter, 4 mm). The indentation created by the PLA96 implant decreased over time compared with that created by the silicone implant. There were no complications related to either kind of implant.

CONCLUSION

Both the silicone sponge implant and the PLA96 implant caused indentation that decreased in a comparable manner over the follow-up period (5 months).

Clinical Case Notes. Scleral buckle intrusion

A case is reported of a 72-year-old man with an intruded scleral buckle presenting 30 years after retinal detachment repair. The lesion was noted incidentally and occupied the superotemporal retinal periphery. The diagnosis was confirmed by B-scan ultrasonography and external examination of the globe. The patient was treated conservatively. No clinical change was evident after 12 months follow up.

Intrusion of an encircling buckle after retinal detachment surgery

PURPOSE

To report a patient with intrusion of the encircling buckle late postoperatively after surgical treatment of a rhegmatogenous retinal detachment.

DESIGN

Interventional case report.

METHODS

We performed an encircling buckle procedure on a 77-year- old woman with a rhegmatogenous retinal detachment. Four years after the operation, the encircling buckle intruded into the vitreous cavity.

RESULTS

After 3 months of diagnosis of the intrusion, the retina was detached totally.

CONCLUSIONS

Intrusion of the encircling buckle without any additional segmental buckling element is a very rare late complication of retinal detachment surgery.