Removal of scleral explant elements: A 10-year retrospective study

Abstract

There are several studies in the American literature on the incidence and causes of retinal redetachment following removal of explants. This is, to our knowledge, the first such study from Britain and differs in its findings from the American experience. The reason for removal of explants, the time of removal after initial detachment surgery and the consequences of removal were reviewed for the 10-year period from 1980 to 1990. During this period 1898 retinal detachment operations were performed at this centre, with an explant removal rate of 3.2% (61 eyes). Extrusion of the element was the cause in 74%. Of these 8% subsequently suffered a redetachment. In two eyes no retinal break was identified at initial surgery. Both of these suffered a redetachment following removal of the explant. Contrary to previous reports, redetachment was not related to short periods of explant or to infection of the explant. This study suggests that explant removal is a safe procedure. However, there is a significant risk of redetachment after explant removal if no breaks are identified at the time of initial surgery.

Buckle-related complications following surgical repair of retinal dialysis

“…13,[16][17][18][19][21][22][23] In this study, there was a low rate of retinal redetachment following removal of buckle (7.7%), and, as mentioned previously, this case was remarkable owing to its complicated primary reattachment surgery, with globe perforation following suture placement. Also, as the buckle was obviously extruding in this particular case to such a degree that it could be safely and painlessly removed at the slit lamp, it is doubtful that this explant was creating an indent sufficient to contribute to a successful surgical outcome, or that its removal actually contributed to retinal redetachment.…”

“…However, it should be noted that the risk of buckle-related complications warranting removal following surgical repair of retinal dialysis was high for all forms of retinal dialysis surgery, irrespective of the type of buckle used. There is a much lower incidence of buckle removal reported in the literature in cases of retinal detachment surgery not limited to retinal dialysis cases (1.3-24.4%); 13,14,[17][18][19][20] however, reports of surgical repair of retinal dialysis have primarily focused on visual and anatomical outcomes, and have failed to report or discuss buckle-related complications following this procedure. [1][2][3][4][6][7][8][9]11 In other words, it is difficult for us to make any meaningful comment on our high rate of buckle-related complications following surgical repair of retinal dialysis.…”

“…It has been suggested that 6 months follow-up is adequate to identify cases of retinal detachment following buckle removal, as most cases that redetach will do so during this period, 21,22 with the highest rate of redetachment occurring within the first 30 days. 21 Risk of retinal redetachment following removal of a scleral explant is reportedly increased in the following instances: relatively short interval between the primary retinal detachment repair and removal of the buckle; 22 the presence of retinal tears, as opposed to holes; 22 if there are no breaks identified at the time of the primary reattachment surgery; 17 the presence of vitreous traction at the time of the initial retinal detachment surgery; 21,22 and greater extent of the original retinal detachment. 21 It is possible that retinal dialysis repair is unlike other types of retinal detachment surgery, with uncomplicated cases having a much lower rate of redetachment following buckle removal.…”

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.…”