Erosion and intrusion of silicone rubber scleral buckle - Presentation andmanagement

Objective: To describe the clinical presentation and management of erosion and intrusion of silicone rubber implants that are used in scleral buckling procedures for the treatment of retinal detachment. Methods: The authors identified four patients from their practices during t he last 20 years (1978 -1998) who had erosion or intrusion of silicone rubb er scleral buckles that were used to manage retinal detachment. Approximate ly 4400 scleral buckling procedures were performed during this period. A re trospective review of the medical records of all patients was performed. Fa ctors that influenced management decisions concerning the intruding buckle are emphasized. Results: All four patients had myopia. The interval between placement of th e scleral buckle and development of intrusion ranged from 1 to 20 years. Th e buckles were intrascleral in three cases and episcleral in one. Recurrent detachment and vitreous hemorrhage were indications for surgical intervent ion in three cases, After the surgical removal of buckling elements, visual acuity stabilized in all patients and the retina remained attached in all cases. Conclusions: Erosion and intrusion of scleral buckle are rare complications of scleral buckling procedures. The intruding buckle may be left intact un less there is significant threat to the integrity of ocular structures, rec urrent detachment, or hemorrhage. Manipulation of the encircling band or bu ckle does not necessarily alter the visual acuity or the status of the reti na.