Scleral Buckle Removal Infrequently Results in Retinal Redetachment

Subsequent retinal redetachment following scleral buckle (SB) removal is uncommon at approximately 6.56%, according to research published in Ophthalmology Retina. The study also shows that patients who undergo the procedure experience a high rate of symptomatic relief, the investigators report.

The observational chart review included 20.5 years worth of records from 86 patients (mean age at the time of SB removal, 59 years, 60% men) who underwent SB removal with an average follow up time of 4.06±4.42 years. Those who had an unplanned or self-explanted scleral buckle removal were excluded. Principal reasons for removal were exposure (61.63%), infection (20.93%), and diplopia or strabismus (19.77%).

While exposure was the top reason for removal among all buckle types, other key indications differed by type. Migration affected 42.11% of those receiving MIRAgel bands. Infection instigated 16.67% of SB removals for patients with silicone sponges. Infections and diplopia lead to removal in 24.44% and 22.22%, respectively, of those with silicone bands.

Frequently reported symptoms and signs included discomfort or pain (65.12%), blurred vision (24.42%), diplopia (22.09%), and drainage or discharge (18.60%).

After scleral buckle removal surgery, 86.59% of participants’ symptoms resolved, according to the investigation. In patients who developed redetachment, it occurred 15.95±25.71 months after removal.

Four smaller, similar analyses of scleral buckle removal outcomes report redetachment rates ranging between 6.86% to 12.00%.

“While our study examined retinal detachment following scleral buckle removal and found rates to be reassuring, it must be acknowledged that there is a risk of recurrent retinal detachment in any patients who have undergone retinal detachment repair, even if a buckle is never placed and subsequently removed,” the researchers explain. “Physicians and patients alike should be aware of the small but real risk of retinal redetachment in all patients.”

Since removal is fairly rare, buckle type groups were small, possibly limiting the data; along with differences in record-keeping among providers. Sixteen buckles were of unidentified type and not input in all analyses. Also, strabismus procedures may not be communicated back to the retina specialist, leading to possible underestimation. This is one of the largest studies yet to compare long-term outcomes with 3 types of buckles.