Objective To the report 20-year follow-up data for patients receiving a scleral buckle for treatment of a primary rhegmatogenous retinal detachment (RRD). Methods Nonconsecutive, retrospective case series. We identified 227 eyes with primary RRD who were treated with a scleral buckle, and for whom at least 20 years of follow-up data were available. Results were classified into 3 subgroups: retina reattached with 1 procedure; retina reattached with 1 or more additional vitreoretinal procedures; or retina detached at 20 years. Results One hundred eighty-six eyes (82%) achieved retinal reattachment with 1 scleral buckling procedure and with a median final visual acuity of 20/40 at 20 years of follow-up. An additional 30 eyes (13%) achieved retinal reattachment after 1 or more additional vitreoretinal procedures, with a median final visual acuity of 20/50. Eleven eyes (5%) were detached at the 20-year follow-up examination, with a final visual acuity in all eyes of no light perception. Conclusions Scleral buckling for primary RRD achieves anatomical efficacy and preservation of central vision in the majority of eyes at 20 years' follow-up. The 1-operation success rate was 82%, overall success rate was 95%, and median final visual acuity was 20/40. This study may serve as a basis for comparison with the long-term results of other surgical techniques used in the treatment of primary RRDs.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/269749/ECS10058.pdf

Twenty-year follow-up for scleral buckling.

Objective To compare long-term complications of silicone sponge, silicone rubber, and MIRAgel used as episcleral buckling elements. Methods Medical reports were reviewed of 805 patients with cryotherapy and episcleral buckle for rhegmatogenous retinal detachment who were operated on by 1 of us (M.R.-P.) between March 1984 and December 1997. Average follow-up was 76 months. Symptoms and signs of infection or rejection were considered. Care was taken in buckling element removal, considering the material used for scleral buckling (detailed operative note), duration of the buckle, cause of removal, and culture of the removed element. Results A total of 757 patients were included in the study. Removal of the implant was necessary in 10 patients (1.3%). Silicone sponge (3 [9%] of 32 patients) was more frequently removed than was silicone rubber (2 [0.6%] of 360 patients) or MIRAgel (5 [1.3%] of 386 patients). Silicone sponge needed to be removed a short time after surgery, showing symptoms of acute infection and positive cultures. Silicone rubber was removed 1 year after surgery with symptoms of chronic infection and positive cultures, and MIRAgel implants were removed after long-term follow-up (7-10 years), showing positive cultures in only 20%. Conclusion Periodic long-term follow-up previously recommended for use of other materials also must be recommended for MIRAgel use because of long-term alterations in its chemical composition and eventual swelling of material.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/1150414/ecs8379.pdf

Long-term complications of silicone and hydrogel explants in retinal reattachment surgery.

Biofilm and scleral buckle-associated infections. A mechanism for persistence

• Six hundred consecutive retinal detachments were operated on with silicone scleral buckles. Twenty-three implants, or 3.8%, were removed. There was one solid silicone implant and 22 silicone sponges. Removal was required because of infection (seven eyes), foreign-body sensation without infection (seven eyes), recurrent subconjunctival hemorrhages (four eyes), impingement on the optic nerve (one eye), and distortion of the macula (four eyes). The postoperative infection rate was 1.8% for silicone sponges, and there were no infections in eyes buckled with solid silicone. Only one retina redetached after buckle removal, yielding a recurrence rate of 4%. The one recurrence was successfully managed by a second scleral buckle.

https://jamanetwork.com/journals/OPHTH/articlepdf/632790/archopht_96_11_011.pdf

The Removal of Scleral Buckles

Cultures of 638 routine preoperative conjunctival specimens prior to retinal detachment surgery demonstrated bacterial contamination with Staphylococcus epidermidis in 37%, S aureus in 3%, Proteus in 1%, Klebsiella in 1%, and Pseudomonas in 0.2%. Postoperative infection with rejection of the scleral implants occurred in 4% (37) of 878 operations. The risk of a clinical infection was increased statistically when a preoperative culture demonstrated pathogenic bacteria, when episcleral solid silicone was used in surgery, and when the procedure was a reoperation. Age, sex, side of surgery, type of anesthesia, aphakia, preoperative contamination with S epidermidis , drainage of subretinal fluid, disinsertion of muscles, or the use of silicone sponges did not influence the vulnerability of the eyes to postoperative infections. The risk of recurrent detachment following surgical removal of the infected materials was found to be 33%.

Infections following scleral buckling procedures.

Thirty-one cases in a series of 127 cases operated on by the Lincoff technique for retinal detachment surgery required removal of the silicone sponge implants. Sponge rejection or infection can be divided into two distinct categories: Early and late. Nine cases were classified early and required removal of the sponge within the first eight weeks following surgery. These cases were a result of contamination at the time of surgery or in the immediate postoperative period. Twenty-three cases required sponge removal between two months and four years following surgery. We believe that mechanical factors affecting the implant are primarily responsible for sponge rejection in these late cases and that infection and foreign body reaction play only a secondary role.

Charles E. Russo

Papers

Silicone Sponge Rejection: Early and Late Complications in Retinal Detachment Surgery