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D. J. Covert, W. J. Wirostko, D. P. Han, J. Hammersley, K. Lindgren, J. E. Kim, T. B. Connor; Risk Factors for Scleral Buckle Removal: A Matched, Case-Control Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4055.
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© ARVO (1962-2015); The Authors (2016-present)
To identify preoperative, perioperative, and postoperative factors during scleral buckle (SB) implantation for rhegmatogenous retinal detachment (RRD) that may increase the risk for subsequent SB removal.
This was an Institutional Review Board (IRB)-approved matched, case-control study at an academic eye institute of patients undergoing SB removal from 1988 to 2007. Each case was matched on year of initial SB implantation to four randomly-selected controls who did not undergo subsequent SB removal; there were no other matched variables.
Forty cases were initially identified, but 3 did not have sufficient medical documentation to include. Therefore 37 cases and 148 controls were included. Three outcome variables were considered: SB removal for any reason, SB removal due to exposure of buckling elements, and SB removal for eyes whose buckling elements appeared clinically infected. For the outcome of SB removal for any reason, univariate analysis revealed the following statistically significant risk factors: diabetes mellitus (odds ratio (OR): 7.3, 95% confidence interval (CI): 1.8--30), prior chronic topical ocular therapy (OR: 4.3, CI: 1.7--11), traumatic etiology of initial retinal detachment (OR: 11, CI: 2.8--40) especially perforating or penetrating trauma (OR: 24, CI: 2.9--200), concurrent pars plana vitrectomy (PPV) (OR: 14.7, CI: 4.2--50), and subsequent ocular procedures (OR: 3.4, CI: 1.5--7.5). After multivariate analysis, the following factors remained independent risk factors: perforating or penetrating traumatic etiology (OR: 61, CI: 4.2--880), diabetes (OR: 15, CI: 2.8--80), subsequent ocular procedures (OR: 3.5, CI: 1.4--8.9), and concurrent PPV (OR: 8.9, CI: 2.5--32 ). Patient age, sex, size of buckling elements, and a temporal location of the scleral buckle sleeve did not increase SB removal risk. Similar risk factors were found for the other two outcome variables of SB removal for exposure and infection.
Preoperative and perioperative factors at the time of SB implantation for RRD--as well as ocular procedures performed subsequently--may increase the risk of subsequent SB removal. Potentially modifiable risk factors included concurrent PPV and subsequent ocular procedures, whereas nonmodifiable risk factors included diabetes mellitus, prior chronic topical ocular therapy, and a traumatic etiology of retinal detachment. Other factors including age, sex, and size of buckling elements did not appear to increase the risk of subsequent SB removal in this study.
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