Pictorial CME
 
Intrusion of Dacron Sutures and A Recurrent Vitreous Hemorrhage: Rare Complication of Scleral Buckle
 
Jignesh Manshibhai Gala1Raja Narayanan2,3
1Topiwala National Medical College and B.Y.L. Nair Charitable Hospital
2Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L.V. Prasad Eye Institute, Hyderabad, India
3Head of Clinical Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India


Corresponding Author
:
Raja Narayanan (MS, MBA)
L V Prasad Eye Institute, Road number 3, Banjara Hills, Hyderabad 500 034,Telangana, India
Email id: narayanan@lvpei.org


Abstract

We present a case of intrusion of a Dacron suture 8 years after scleral buckling surgery. Though rare, scleral buckle has to be removed if it is associated with complications like intrusion or extrusion, infection, or anterior segment ischemia. In this report we highlight a case of intrusion of Dacron sutures and high buckle indent leading to retinal ischemia, neovascularization and recurrent vitreous hemorrhage. We managed this case by buckle removal but we could not remove the subretinal Dacron sutures.

A 29-year-old gentleman presented to us with a chief complaint of on and off painless decrease in vision in the right eye. Past history of blunt trauma with cricket ball 8 years ago for which he underwent a scleral buckling. At the time of presentation BCVA in the right eye was hand motions. On slit-lamp examination sutures of scleral buckle were seen (Figure 1). Fundus showed hazy view due to vitreous hemorrhage. The patient was planned for vitreoretinal intervention in the right eye.


Figure 1: Slit lamp photo of the right eye shows a 5-0 polyester Dacron suture below the conjunctiva (yellow arrow)

Intraoperatively after clearing vitreous hemorrhage, a very high buckle indent was noted which obscured the visualization of the temporal retina. The temporal periphery of the retina was ischaemic with areas of neovascularisation. Also, an intrusion of 5-0 polyester dacron suture was noted at 9 o'clock position (Figure 2). Pars plana vitrectomy with silicone oil injection with endolaser was performed to settle the retina in the right eye.


Figure 2: A colour fundus photo (Optos, Marlborough, MA, USA) of the right eye shows an attached retina post pars plana vitrectomy with silicone oil insertion. A 5-0 polyester Dacron suture seen at 9 O’clock (White arrow). Areas of neovascularisation with hemorrhages seen at peripheral to high buckle indent (white arrowhead). The temporal retina could not be visualized due to a tight buckle. There is no intraocular inflammation as evidenced by the media clarity.

Best corrected visual acuity in the right eye improved to 20/100p. Later on during oil removal scleral buckle was also removed. 
In conclusion, we report a rare complication of scleral buckling procedure of recurrent vitreous hemorrhage and intrusion of Dacron suture due to tight buckle.

Take Home Message: 
1) The excessively tight buckle can lead to recurrent vitreous hemorrhage and intrusion of buckle or scleral suture.
2) Asymptomatic cases of scleral suture intrusion can be observed.

References
  1. Tsui I. Scleral Buckle Removal: Indications and Outcomes. Survey of Ophthalmology, 2012; 57(3):253–63.
  2. Papakostas TD, Vavvas D. Postoperative Complications of Scleral Buckling. Seminars in Ophthalmology, 2018; 33(1):70–74.
  3. Chronopoulos A. Complications of Encircling Bands-Prevention and Management. Journal of Clinical & Experimental Ophthalmology, 2015; 6(3).