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Kim and Heo: A Case of Silicone Band Migration Following an Encircling Procedure
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(3): 347-351.

Published online: 15 March 2017

DOI: https://doi.org/10.3341/jkos.2017.58.3.347

A Case of Silicone Band Migration Following an Encircling Procedure

Mi Jin Kim, MD, Jang Won Heo, MD, PhD

Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Address reprint requests to Jang Won Heo, MD, PhD. Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-0836, Fax: 82-2-741-3187, jangwonheo@gmail.com

Received 27 October 2016       Revised 29 November 2016       Accepted 17 February 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In the present study, a case of silicone band migration following an encircling procedure was reported.

Case summary

A seven-year-old male was admitted to our hospital after undergoing primary corneal suture and cataract extraction for traumatic corneal laceration and cataract in the left eye at another hospital. The cornea was well sutured, but due to vitreous bleeding and retinal detachment, we performed vitrectomy and silicone oil injection in combination with scleral buckling. The retina was well attached for 7 months following the procedure but the silicone oil was removed due to uncontrolled intraocular pressure elevation. Ten days later, the patient was readmitted for blurred vision in the left eye and vitreous bleeding as well as superotemporal retinal detachment were observed. During vitrectomy, we could not locate the indentation caused by scleral buckle, therefore extraocular area was closely examined. The scleral fixation sutures were well maintained in all 4 quadrants but the silicone band was not observed within the sutures. The band was located anterior to the fixation sutures and was displaced anterior to the medial rectus muscle insertion. The encircling silicone band was removed. The encircling procedure was again performed with a new silicone band combined with vitrectomy and silicone oil injection. Retinal attachment has been maintained and the silicone band well anchored since the operation.

Conclusions

Anterior migration of the silicone band through the outer layer of the sclera or one or more tendons of recti muscles is a rare but potential complication of scleral buckling. Hence, clinicians must note the possibility of this complication when retinal detachment recurs and the encircling buckle is not observed.

Keywords: Anterior migration, Encircling buckle, Retinal detachment, Retinal surgery, Silicone band

Figures and Tables

Figure 1

Intraoperative photographs reveal anterior migration of the silicone band eroding through the scleral layer or the tendon of rectus muscles. It has been suggested that the encircling band ‘cheese wires’ or slips forward through the rectus muscle insertion. (A) From the surgeon's perspective, the encircling band was shifted anterior to the scleral anchoring suture, and particularly, even more anterior to the medial rectus. (B) From the superonasal view, a posterior intact scleral suture is shown (black arrows), and the encircling band is not seen between the scleral sutures. The encircling band (blue arrows) was located more anterior to the medial rectus and superior rectus insertion (yellow arrows). (C, D) From the inferonasal view as well, the encircling band (blue arrows) was seen most anteriorly, followed by the insertion of the inferior rectus and medial rectus (yellow arrows) and the empty scleral suture (black arrow). (E) From the inferotemporal view, the intact scleral suture (black arrow) appears to be empty, and (F) the encircling band (blue arrows) is anterior to it. (F) Here, hemorrhage is observed in the area from which (black arrow) the scleral suture has been removed. (G) Finally, from the superotemporal view, the scleral suture is located most posteriorly (black arrow), followed by the encircling band (blue arrows) and lateral rectus insertion, which were anterior to it, in this order. The intact scleral suture has been removed (H), and the encircling band completely fixed by the sleeve has been released from the sleeve and removed. IR = inferior rectus; LR = lateral rectus; MR = medial rectus; SR = superior rectus; Lt = left.

jkos-58-347-g001
Figure 2

The encircling band ‘cheese wires’ forward through the sclera or rectus muscle insertion. As an anterior sliding band slowly erodes through the sclera or rectus muscle insertion, there is sufficient time for the muscles to reattach spontaneously with scar tissue behind the migrating element.

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Table 1

Anterior migration of scleral explants

jkos-58-347-i001

RD = retinal detachment; MA = months ago; YA = years ago; PPV = pars planar vitrectomy; IVGI = intravitreal gas injection; CB = circumferential buckling.

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