Scleral Buckle Removal: Long-term Patient Outcomes

Abstract

Purpose : Scleral buckling has been a successful course of management for repairing primary rhegmatogenous retinal detachments. Occasionally, patients require their removal. While outcomes in this subset of patients have been investigated, there have not been any large patient series to be able to reach any conclusions. Long term sequelae of scleral buckle (SB) removal is debated in the literature, specifically around the risk of re-detachment. We performed a retrospective observational study evaluating the clinical indications for and outcomes following scleral buckle removal.

Methods : A retrospective chart review of 87 patients with history of SB removal between June 1^st, 2000 and January 1^st, 2021 at a large academic center and associated private retina practice in Chicago, IL was completed. Exclusion criteria included unplanned or self-explanted scleral buckle removal. Primary outcomes measured include patient symptoms prior to SB removal, indications for removal, resolution of symptoms following removal, rate of redetachment, rate of additional ocular surgery, and changes in visual acuity and intraocular pressure. Secondary outcomes will include identifying factors associated with poorer outcomes.

Results : A total of 87 eyes with history of SB removal were included with an average follow-up of 4 years. About 60% were males and the mean age at the time of SB removal was 58 years. The leading indications for removal were exposure (53 eyes, 60.9%), infection (18 eyes, 20.7%), and diplopia/strabismus (17 eyes, 19.5%). The average time from SB placement to removal was 12.1 years (SD ±11.2). Most patients presented with symptoms, specifically of pain and discomfort (57 eyes, 65.5%), diplopia (19 eyes, 21.8%), and drainage/discharge (16 eyes, 18.4%). Of these patients, 92.7% experienced symptom resolution following SB removal. Notably, only 5.75% of all eyes (5 eyes) experienced a re-detachment requiring surgery. Within this subset, the average time from SB placement to removal was 1.87 years (SD ±1.78) and time to re-detachment following removal was 13.0 months (SD ±23.2 months). Nine percent of all eyes required additional strabismus or oculoplastic surgery.

Conclusions : Overall, our review demonstrates that the removal of scleral buckle provides a high rate of symptomatic relief and low risk of subsequent detachment. Nonetheless, close monitoring is warranted to monitor for a recurrent retinal detachment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.