Outcomes and Complications of Hydrogel Scleral Explant Removal

Abstract

To report symptoms of extrusion of hydrogel explants after retinal detachment (RD) repair and the outcomes and complications following removal. All 23 patients had previous RD repair by episcleral buckle with hydrogel explant. Signs and symptoms of scleral buckle (SB) extrusion were analyzed. Main outcomes measured were redetachment of the retina, persistent diplopia, and decreased postoperative visual acuity (VA). Mean time between RD repair and removal of extruded SB was 16.2 years (range: 11 to 21 years). Fifteen patients (65%) received encircling SB and 8 had segmental SB. SB was combined with vitrectomy in 12 patients and 3 received silicone oil. Common complaints included limited ocular motility, presence of a palpable mass under the eyelid, pain and discomfort, diplopia, visible SB under eroded conjunctiva, complete immobility, and signs of infection. Two eyes were phthisical. No scleral perforations occurred during removal of explants. After SB removal, RD recurred in 2 patients and diplopia persisted in 4. VA was not affected by SB removal. Deterioration may occur after implantation for 10 years or longer. This is due to microstructural change of the hydrogel material. The most common problems are motility disturbance and presence of a tumor-like, palpable mass under the eyelid. Removal of the implant can alleviate some ocular problems. However, RD can recur and diplopia may persist after removal of the SB. Vision usually is not affected.