![]() On examination in the emergency department, his VA was 20/40 OD and 20/20 OS. Postoperatively, he was treated with 1% prednisolone acetate one drop four times per day and 0.5% ketorolac one drop twice per day in the right eye. He underwent multiple scleral buckle revisions, most recently in October 2021. He returned to his surgeon and was told that his scleral buckle was exposed. He was seen by his original surgeon who trimmed an “exposed suture,” following which his symptoms worsened. In July of 2021, he developed recurrent episodes of pain and discharge in his right eye. He experienced a redetachment in late 2015 that required repeat surgery with a scleral buckle, PPV, and gas tamponade. He underwent uncomplicated cataract surgery and IOL placement in the capsular bag in 2015, after which he developed an RD in his right eye that was repaired with PPV and gas tamponade. He had no past medical history, but his ocular history was robust. THE CASEĪ 73-year-old man presented to the emergency department 1 month after a scleral buckle revision with complaints of sudden worsening of ocular pain that woke him up in the middle of the night. Here, we present a case of an extruded silicone scleral buckle with associated scleral thinning and a large conjunctival defect and the surgical steps we took to treat the patient. 10 Larger defects are difficult to close because of the location typically near the conjunctival fornix, loss of tissue integrity due to necrosis, and limited mobility of the surrounding conjunctival tissue due to scarring and adhesions.Īdjunct techniques such as the use of dehydrated amniotic membrane graft secured with fibrin sealant have been shown to successfully repair large conjunctival defects secondary to an extruded buckle. Similarly, primary closure of a small defect may be attempted but is typically futile with frequent recurrence. 9 Observation of the exposed elements coupled with topical antibiotic drops has generally been found inadequate. ![]() 2-9 Despite few implants being removed for suspected clinical infection (8.2%), a majority of the extruded and subsequently removed buckles have been shown to be colonized with bacteria. 1 One of the most frequent indications for silicone scleral buckle removal is extrusion through the conjunctiva with rates of extrusion and infection ranging from 0.5% to 5.6%. Scleral buckling remains a popular technique to repair retinal detachments (RDs), either as primary treatment or as an adjunct to pars plana vitrectomy (PPV). ![]() When faced with an extruded scleral buckle, consider using scleral and amniotic patch grafts.Amniotic membrane grafts have been well reported in the reconstruction of the conjunctiva for numerous ocular surface diseases.One of the most frequent indications for silicone scleral buckle removal is extrusion through the conjunctiva.Patients will need to wear protective eyewear for a certain amount of time afterwards as well. Doctors will also advise about limiting solids and liquids before the procedure. The doctor will advise patients of any medications they will need to stop taking prior to the procedure. Patients will need to make arrangements for a ride after the procedure. This procedure is done under local anesthetic. Some surgeons may choose a temporary buckle for simple retinal detachments, using a small rubber balloon that’s inflated and later removed. The buckle usually remains in place for the rest of the patient’s life. Before tying the sutures that hold the buckle in place, the surgeon may make a small cut in the sclera and drain any fluid that has collected under the detached retina. The scleral buckling material is stitched to the outer surface of the sclera. If there are several tears or holes or an extensive detachment, the surgeon may create an encircling scleral buckle around the entire circumference of the eye. The silicone material indents the wall of the eye, creating a buckling effect and reducing traction of the vitreous on the retina. ![]() The surgeon will then attach a small piece of silicone sponge or a firmer piece of silicone rubber to the affected part of the sclera, or white of the eye. What to expectįirst the surgeon will treat the tears with cryopexy, a procedure that uses intense cold to destroy some tissue. This method bends the wall of the eye inward so it meets the wall of the retina. Scleral buckling is one of the most common surgeries for repairing a retinal detachment.
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