Scleral and episcleral histological changes related to encircling explants in 20 eyes

Abstract

ABSTRACT.Purpose: To investigate scleral and episcleral histological alterations induced by encircling explants used in scleral buckling procedures. Methods: We performed a histopathological study of 20 enucleated eyes after failure of retinal detachment surgery including encircling scleral buckle. Results: Nonabsorbable materials were encapsulated and often gave rise to a limited scleral invagination. The inner capsular surface was regular in 10 silicone explants, it was partially covered with hydrogel fragments and a granulomatous foreign body giant cell reaction in 8 hydrogel explants. One Arruga thread was encased in fibrosis and a catgut circle showed no encapsulation. Other changes were mostly related to the long-standing retinal detachment: peripheral anterior synechiae, anterior uveal effusion, persistent retinal detachment, retinal gliosis, retinal atrophy, retinal breaks, and silicone oil droplets. Conclusion: All nonabsorbable explants underwent encapsulation and prompted scleral invagination. A granulomatous reaction accompanied hydrogel fragmentation. The long term fragmentation impact on implanted eyes remains unknown.

Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment

“…8 These haemodynamic changes may alter the polarity of the RPE and lead to fluid leakage. Conversely, inflammation induced by scleral buckling itself may be the source of the subfoveal fluid.…”

Foveal detachment after successful retinal reattachment for macula on rhegmatogeneous retinal detachment: an ocular coherence tomography evaluation

“…Conversely, inflammation induced by scleral buckling itself may be the source of the subfoveal fluid. 10,11 It is possible that the isolated area of subfoveal fluid could be the result of fluid movement from the original location of the RD towards the posterior pole during the surgery or afterwards. Theodossiadis et al 6 speculated that the proximity of the RD to the fovea was indeed the cause of this occurrence as in two out of three of their patients with postoperative submacular fluid, the posterior border of RD was within the range of 1.5-3.5 DD of fixation.…”

Scleral buckling biomaterials and implants for retinal detachment surgery

“…At present, silicone is commonly considered the material of choice in scleral buckling procedures due to its excellent biocompatibility, chemical inertness and long-term stability in vivo. Silicone implants have been extensively reported to be well tolerated by ocular tissue [6,10,45,46]: in general, a slight inflammatory reaction occurs during the first months after surgery, whereas only a capsule layer without inflammatory cells is detected around the implant after long-term follow-up periods (18-204 months [47]). However, even with careful operative techniques and appropriate materials/implants design, evidences of adverse local tissue reactions and postoperative long-term complications have been occasionally reported, such as persistent inflammation, dramatic increase of intraocular pressure (IOP), scleral thinning/erosion under the implant, intrusion into the vitreous cavity, migration/extrusion of the implant, alteration of ocular blood circulation, diplopia, pain and foreign body sensation [48][49][50][51][52][53][54][55][56][57][58][59].…”

“…Specifically, PGMA was found to suffer from a lack of tensile strength when swollen and PHEA exhibited a dramatic tendency to fragment after swelling [95]. MAI implants, which could be placed both intrasclerally and episclerally, seemed to offer better bulk features and were found to promote the formation of a strong surrounding capsule of connective tissue [45,47,100,101]; although after 3 weeks from implantation a mild inflammatory response was generally detected, after 3 months almost no inflammatory cells were found [88]. In spite of their excellent biocompatibility, however, in many cases MAI buckles need to be removed due to foreign body sensation, ocular motility limitations, subconjunctival bulge or pain complained by patients [96,97,99].…”