Scleral explant removal: the last decade

Abstract

Purpose To examine the reasons for and outcomes of the scleral explant removal over the last decade. Methods A case note review of patients undergoing scleral explant removal in the operating theatre over a period of 10 years from January 1990 to December 1999. The following information was retrieved: age, sex, reason for explant removal, duration of explant (ie interval between primary surgery and explant removal), type of explant, symptomatic relief, preoperative and postoperative retinal status including redetachment, causes for redetachment, and follow-up. Mann-Whitney U-test and Fisher's exact test were used for statistical analysis. Results A total of 72 patients were eligible for the study. The average age was 54.1717.0 years (range, 17-84 years). The mean duration of explant was 50.1 years (range, 1-282 months) and mean follow-up was 18.3 months (range, 4-120 months). In all, 51 (70.8%) patients had a sponge silicone explant, 13 (18%) patients had a solid silicone explant, whereas eight (11.1%) patients had a combination of the two. The commonest reason for the explant removal was extrusion (n ¼ 34, 47.2%) closely followed by pain (n ¼ 29, 40.2%). Symptomatic relief was achieved in 88% of patients. Six patients (8.3%) suffered retinal redetachment post explant removal. There was no statistically significant correlation between the reason for the removal or the duration of the explant and retinal redetachment. The majority (N ¼ 5) of redetachment occurred within 6 months of the explant removal (Po0.01). Conclusion The Scleral explant removal provides symptomatic relief to the majority of patients, but is associated with a small risk of redetachment especially within 6 months postoperatively.

Risk Factors for Scleral Buckle Removal: A Matched, Case-Control Study

“…Rarely, SBs can be associated with complications and require removal in 1% to 24% of cases. [1][2][3][4][5][6][7][8][9] Reported indications for SB removal are numerous and include SB exposure, SB extrusion, migration of SB elements, [4][5][6][7][8][9][10][11][12][13][14][15] intrusion of SB, 13,[16][17][18][19][20] infection, 2,6-8,10,13 chronic pain, inflammation, foreign body sensation, 3,6,7,9,13,14,21 strabismus and diplopia, [6][7][8][9]10,11,14,21 recurrent subconjunctival hemorrhage, 3 macular distortion, 3 impingement of the optic nerve, 3 swelling of buckle elements, 11,21 granuloma, 10,11 sudden loss of vision, …”

“…22 Removal of buckling elements is a significant event, as it can result in scleral perforation, 11,14 endophthalmitis, 14,23 and recurrent RD in 0% to 34% of cases. [1][2][3][6][7][8]10,11,13,14,24,25 Although prior studies have investigated complications of SB removal, [2][3][4][5][8][9][10][11] we are not aware of any recent large case-control study on risk factors for SB removal.…”

A Novel use of Dermis Fat Graft for the Repair of an Exposed Scleral Buckle

“…Risk factors include a history of multiple retinal detachments, persistent vitreoretinal traction, proliferative vitreoretinopathy, aphakia with multiple posterior breaks, exposures with retina attached for a short duration, and lack of detecting retinal holes/tears at the time of the original RD repair [6][7][8]. In our monocular patient with Stickler Syndrome contributing to multiple retinal detachments and a recent SB placement of less than six months, there would have been high risk of retinal re-detachment upon SB removal.…”

“…SB removal leads to retinal re-detachment in 8-14.5% of patients, especially when done within six months of SB placement [6,7]. Risk factors include a history of multiple retinal detachments, persistent vitreoretinal traction, proliferative vitreoretinopathy, aphakia with multiple posterior breaks, exposures with retina attached for a short duration, and lack of detecting retinal holes/tears at the time of the original RD repair [6][7][8].…”

The Use of Polymers in the Treatment of Retinal Detachment: Current Trends and Future Perspectives

“…Although silicone implants are generally considered as -the gold standard‖ solution for scleral buckling, and rightly so they can occasionally induce some or even all the long-term complications listed in Table 2, as underlined by recent studies [76,77].…”