J Korean Ophthalmol Soc.  2019 Jul;60(7):696-700. 10.3341/jkos.2019.60.7.696.

Utilizing a Previous Silicone Band Track in Recurred Retinal Detachment

• Kim Y
• Choi KS

• KMID: 2453022
• DOI: http://doi.org/10.3341/jkos.2019.60.7.696

Abstract

PURPOSE
We report a case of utilizing a previous silicone band track in the reoperation of scleral encircling.
CASE SUMMARY
An 8-year-old male presented with rhegmatogenous retinal detachment in the right eye. Five days after this diagnosis, he received scleral buckling surgery and cryopexy to seal the retinal tear. One month after surgery, a fundus examination showed subretinal fluid at the inferior site of the scleral buckle. He underwent scleral encircling surgery and a cryopexy procedure. The patient has had an uneventful postoperative course, and the retina has remained attached over a follow-up period of 9 months. However, exotropia and hypotropia developed in the right eye. Diagnosis of restrictive strabismus due to tissue adhesion around the silicone band was made. The encircling band was therefore removed and laser photocoagulation was performed 360° around the retina. Twenty-four hours after surgery, a fundus examination showed subretinal fluid. He received 360° scleral encircling surgery not using the 360° conjunctival peritomy. After confirming a previous encircling tract using #0-0 polydioxanone as a guide, #5-0 Nylon was tied to the end of the guide and inserted through the encircling tract with the end sutured with the silicone band. The silicone band was inserted into the encircling tract by pulling the #5-0 Nylon as a guide. Ophthalmoscopy revealed an attached retina with indentation of the scleral buckle at 360°.
CONCLUSIONS
For reoperation in patients who previously underwent scleral encircling surgery, using the previous scleral encircling tract may be effective in cases with conjunctival and tissue adhesion.

Keyword

Conjunctival peritomy; Reoperation; Retinal detachment

MeSH Terms

Child
Diagnosis
Exotropia
Follow-Up Studies
Humans
Light Coagulation
Male
Nylons
Ophthalmoscopy
Polydioxanone
Reoperation
Retina
Retinal Detachment*
Retinal Perforations
Retinaldehyde*
Scleral Buckling
Silicon*
Silicones*
Strabismus
Subretinal Fluid
Tissue Adhesions
Nylons
Polydioxanone
Retinaldehyde
Silicon
Silicones

Figure

• 

  Figure 1 Fundus photographs and Hess screening test of the patient. (A) Fundus photograph image at the first visit. Retinal tear at 9 o'clock direction and retinal detachment were observed. (B) Postoperative Hess screening test of the patient 9 months after scleral encircling. Exotropia and hypotropia developed in the right eye. (C) Postoperative fundus photograph 1 day after scleral encircling band removal and laser indirect ophthalmoscope photocoagulation showing subretinal fluid, decreased buckle height and laser scar. (D) Postoperative fundus photograph 1 day after re-operation of scleral encircling showing the sufficient buckle height and retinal attachment.

• 

  Figure 2 Intraoperative photographs from the surgeon's perspective reveal the operative procedure using the previous encircling tract. (A) Medial conjunctival peritomy (black arrows) and medial rectus muscle dissection (blue arrow) were done. (B) After confirming the previous encircling tract, 0-0 polydioxanone (PDS) (black arrow) was inserted through the encircling tract (yellow arrow). (C) The 5-0 Nylon was tied to the end of 0-0 PDS and using 0-0 PDS as a guide, 5-0 Nylon (blue arrow) was inserted to the encircling tract (yellow arrow). (D) The 5-0 Nylon was sutured to the 40 silicone band and using 5-0 Nylon as a guide (blue arrow), silicone band (white arrow) was inserted to the encircling tract (yellow arrow). (E) Silicone band (white arrows) was placed beneath the four rectus muscles and was fixed by the clip. MR = medial rectus.

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