Complications of hydrogel explants used in scleral buckling surgery

PURPOSE: To report a group of patients with symptoms of pain, strabismus, sensation of orbital fullness, and presence of a subconjunctival mass many years after successful scleral buckling surgery using hydrogel explants. DESIGN: We present an interventional consecutive case series of patients who underwent scleral buckling surgery using hydrogel explants from 4 to 14 years before onset of clinical symptoms. SETTING: This is a retrospective, multicenter clinical study. Patient population: 17 eyes of 15 patients presented with this disorder. All patients were examined; Snellen acuity, ocular motility, tonometry, slit lamp, and fundus examination were recorded. Two patients underwent either computed tomography or magnetic resonance imaging. Removal of the hydrogel explant was attempted in all patients. Removal of the buckle was technically difficult; the hydrogel material was fragile and fragmented when handled. RESULTS: All patients had prompt relief of pain and discomfort. Ocular motility and diplopia were greatly improved. Extraocular muscle surgery was not required in any case. Three eyes had intraoperative eye wall perforation. One eye developed postoperative bacterial endophthalmitis. Five eyes had recurrence of retinal detachment. One eye had additional complications of corneal edema and glaucoma. CONCLUSIONS: Patients who develop this clinical condition should be considered for removal of the hydrogel scleral buckle. Early recognition of this condition may prevent serious complications associated with delayed removal.