Scleral Buckle Displacement: Symptoms and Concerns

Issues related to scleral buckle displacement?

Hello, Doctor: My situation is that I underwent scleral buckle surgery 20 years ago (at Cathay General Hospital in Taipei).
Recently, I have experienced tenderness in the upper part of the surgical eye (approximately at the 12 o'clock position of the eyeball).
The symptoms are non-continuous; they last for a few days when they occur and then resolve without any sensation.
The appearance of my eye is normal, with no significant redness or swelling.
During this period, I have been using "Zhi Nao Min" (an antihistamine), and the condition seems to improve somewhat; usually, after 1-2 days of use, there is a noticeable improvement in symptoms.
However, a friend of mine who also underwent scleral buckle surgery (with the same surgeon and around the same time) mentioned that his buckle has shown signs of bulging and displacement, resulting in a more pronounced protrusion of his eyeball.
However, the surgeon advised against removing the buckle to avoid a second detachment.
I would like to ask:
1.
Does a scleral buckle necessarily deteriorate over time? Since my buckle was placed 20 years ago, I am unsure if the material's stability is sufficient for lifelong use.

2.
If there is displacement, can the buckle be removed? I consulted a retina specialist who was not involved in my original surgery, and he stated that there should be no signs of displacement currently.
However, he also warned that if the sutures were to break, it could cause discomfort and displacement.
I am very concerned about my appearance, and if there is a protrusion in my eyeball, I would find it unacceptable.
Yet, the surgeon advised my friend against removal, which causes me anxiety about my future condition.

3.
Besides the buckle, could there be other possible causes for the discomfort in the upper part of my eyeball? For instance, I have severe allergies and experience a runny nose year-round; every morning I wake up with my eyes crusted shut.
That is why I have "Zhi Nao Min," primarily for itching relief.
However, since I always see a retina specialist for my eye care, they tend to focus more on my retinal condition.
I would appreciate your guidance on these matters.
Thank you!

Joyce, 30~39 year old female. Ask Date: 2014/01/28

Dr. Wang Zhangji reply Ophthalmology

Your condition is more likely to be chronic or allergic conjunctivitis.
Don't worry about issues that have not yet occurred.
There are pros and cons to removing the ring, and it can also be repositioned.
What you should do is to have regular check-ups and let your physician determine the most appropriate treatment.

Reply Date: 2014/01/28

More Info

Scleral buckle surgery is a common procedure used to treat retinal detachments. It involves placing a silicone band around the eye (the sclera) to help reattach the retina. While this procedure is generally safe and effective, patients may experience various symptoms and concerns over time, especially many years post-surgery, as you have described.

1. Durability of the Scleral Buckle: The materials used in scleral buckles are designed to be biocompatible and stable over long periods. Most scleral buckles are made from silicone or other inert materials that do not degrade significantly over time. However, individual responses can vary, and factors such as the body’s healing response, the presence of inflammation, or other ocular conditions can influence the long-term stability of the buckle. It is not typical for a scleral buckle to "expire" or degrade to the point of causing problems within a lifetime, but it is essential to have regular follow-ups with your ophthalmologist to monitor its condition.

2. Displacement of the Scleral Buckle: If a scleral buckle is displaced, it can potentially cause discomfort or changes in the appearance of the eye. However, the decision to remove or adjust a buckle is complex and depends on various factors, including the degree of displacement, the presence of symptoms, and the risk of retinal detachment recurrence. Your friend's situation, where the buckle has caused noticeable protrusion, is a valid concern. Still, the recommendation against removal is often based on the risk of complications, such as re-detachment of the retina. If you are experiencing discomfort, it is crucial to communicate this with your ophthalmologist, who can assess whether the buckle is indeed displaced or if other factors are contributing to your symptoms.

3. Other Causes of Discomfort: The discomfort you are experiencing in the upper part of your eye could be due to several factors unrelated to the scleral buckle. Allergies, as you mentioned, can lead to chronic irritation and inflammation of the conjunctiva (the membrane covering the eye), which might cause discomfort. Additionally, conditions such as dry eye syndrome, blepharitis (inflammation of the eyelids), or even sinus issues can contribute to ocular discomfort. Since you have a history of allergies and experience symptoms like nasal congestion and eye discharge, it is possible that these factors are exacerbating your eye discomfort.
Given your concerns about the appearance of your eye and the potential for buckle displacement, it would be prudent to seek a comprehensive evaluation from a retinal specialist. They can perform detailed imaging studies, such as ultrasound or optical coherence tomography (OCT), to assess the position of the buckle and the health of your retina.
In summary, while scleral buckles are generally durable and effective, any new symptoms or changes in your eye should be evaluated by a qualified ophthalmologist. They can help determine the cause of your discomfort and whether any intervention is necessary. Regular follow-ups are essential to ensure the long-term health of your eyes, especially after a surgical procedure like scleral buckle placement.

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