The persistence of buckle height in relation to orientation of buckle fixation. An ultrasonographic study

Recurrence of Retinal Detachment after Scleral Buckle Removal

Purpose

To investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.

Methods

In this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.

Results

Forty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).

Conclusions

Scleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.

PERSISTENCE OF INDENTATION WITH BIOABSORBABLE POLY-l/d-LACTIDE VERSUS SILICONE SPONGE SCLERAL BUCKLING IMPLANTS

PURPOSE

To measure the amount and duration of indentation depth achieved with biodegradable poly-L/D-lactide 96/4 (PLA96) and silicone sponge implants.

METHODS

Thirty rabbits underwent a scleral buckling procedure. A PLA96 buckling implant was used in 15 rabbits and a silicone sponge buckling implant was in 15 rabbits. A circumferential scleral buckling implant was sutured episclerally on the left eye of each rabbit, just temporal to the superior rectus muscle and 7 mm posterior to the limbus. Computed tomography was performed at 1 week, 3 months, and 5 months after surgery.

RESULTS

The PLA96 buckling implant (implant diameter, 3-3.5 mm) used in this study created lower indentation than the silicone sponge implant (implant diameter, 4 mm). The indentation created by the PLA96 implant decreased over time compared with that created by the silicone implant. There were no complications related to either kind of implant.

CONCLUSION

Both the silicone sponge implant and the PLA96 implant caused indentation that decreased in a comparable manner over the follow-up period (5 months).

THE MACULAR BUCKLING PROCEDURE IN THE TREATMENT OF RETINAL DETACHMENT IN HIGHLY MYOPIC EYES WITH MACULAR HOLE AND POSTERIOR STAPHYLOMA

PURPOSE

To evaluate the long-term anatomical and functional results of the macular buckling procedure in myopic macular hole with retinal detachment and posterior staphyloma.

METHODS

Twenty-five consecutive highly myopic eyes with retinal detachment, macular hole, and posterior staphyloma, which were operated between February 1983 and April 1992, were retrospectively studied. The last examination was in June 2002. Follow-up of the 25 patients ranged from 10 years to 19 years (mean, 15 years). Macular buckling with an episcleral sponge was the initial and only procedure. In all operated eyes, anchoring of the sponge was away from the posterior pole. Best-corrected visual acuity was evaluated before and after surgery. The axial length of the eyeball was also measured by A-scan ultrasonography before treatment.

RESULTS

Twenty-two of 25 eyes were successfully treated with a single procedure. In the remaining three eyes, retinal reattachment was obtained after a second buckling operation, which was considered necessary due to loosing of the sponge fixation sutures in two cases and the location of the hole beside the buckle in one case. The mean overall visual acuity was improved after treatment.

CONCLUSIONS

The macular buckling procedure with anchoring of the sponge away from the posterior segment provided efficient scleral indentation of long duration for closure of the macular hole and retinal reattachment.