Abstract
Purpose: :
Despite the high success rate of retinal reattachment with scleral buckle (SB) placement, patients occasionally require SB removal for a variety of indications. The goal of this study was to determine if SB removal succeeded in relieving the symptoms and signs that prompted removal. A secondary goal was to describe the rate of retinal redetachment following SB removal.
Methods: :
IRB-approved, retrospective case series of all patients who underwent SB removal between 1988 and 2007 at a single academic eye center.
Results: :
Thirty-seven eyes were identified. Primary indications for removal were exposure without clinical infection (n=16), clinical infection without exposure (n=6), clinical infection with exposure (n=6), migration without exposure causing foreign-body sensation or dysaesthesia (n=2), glaucoma requiring shunt placement (n=1), and inhibition of the growth of the eye (n=1). Secondary indications for removal included preoperative pain or discomfort in 33 eyes and strabismus with diplopia in two eyes. Mean follow-up was 73.2 months; all but two patients had at least three months follow-up. All who underwent SB removal for exposure of buckling elements did well postoperatively with resolution of infection (when present) and resolution of symptoms related to secondary indications for removal. Preoperative infection was cleared in all patients undergoing removal for infection with or without exposure. All five patients who experienced chronic irritation found symptomatic relief after surgery. The two patients with SB element migration had resolution of the foreign body sensation and dysaesthesia. The single patient who needed a glaucoma shunt device placed underwent successful glaucoma surgery that lowered the intraocular pressure and relieved preoperative pain. The single patient undergoing SB removal to allow growth of the eye showed eye growth, but it remained smaller for age. Regardless of primary indication, 31 of 33 patients (94%) reported relief from pain, discomfort, and/or foreign body sensation. Both patients with diplopia reported resolution of symptoms. Only one patient (2.7%) suffered a recurrent retinal detachment within the observed follow-up period; this patient was noted to have proliferative vitreoretinopathy (PVR) prior to SB removal. No other postoperative complications, including endophthalmitis, vitreous hemorrhage, or vitreous loss occurred.
Keywords: retinal detachment • vitreoretinal surgery • clinical (human) or epidemiologic studies: outcomes/complications