Removal of scleral buckle: indications, long-term outcomes and comparison with the literature

Abstract Objective To assess the clinical indications for scleral buckle removal (SBR) and evaluate the functional and anatomic outcomes, including the risk of recurrent retinal detachment (RD) following SBR. Design Retrospective chart review. Methods A single-center analysis of patients operated for SBR was conducted at the Centre hospitalier universitaire de Québec – Université Laval in Quebec, Canada between 2008 and 2023 with a minimum of 1 year follow-up. Data were gathered on preoperative characteristics, indication for SBR, time to SBR, surgical techniques used and postoperative outcomes including final best-corrected visual acuity (BCVA). The primary outcome was the incidence of recurrent RD after SBR. Results Among 2375 eyes that had placement of scleral buckle for RD, 35 (1.5%) required SBR. Infection (34%) and pain (31%) were the most common reasons for SBR. The median time from buckle placement to removal was significantly shorter for infectious cases (2.4 months) compared to non-infectious cases (12.6 months) ( p = 0.006). Four patients (11%) experienced recurrent RD, with 3/4 of those cases occurring when buckle explantation was performed within the first month. Postoperative BCVA at final follow-up improved from logMAR 0.70 to logMAR 0.30 (Snellen equivalent of 20/100 to 20/40). A multivariate logistic regression analysis demonstrated no statistically significant predictors of recurrent RD. Conclusion Infection and pain are the leading indications for SBR, with infections requiring earlier removal. Recurrent RD occurred in 11% of cases, especially with early removal, with all recurrences occurring within 3 months of SBR. Despite these risks, visual outcomes post-SBR are generally favorable. Close monitoring during the early postoperative period is therefore recommended.