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

Removal of scleral buckle: indications, long-term outcomes and comparison with the literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Removal of scleral buckle: indications, long-term outcomes and comparison with the literature Eunice Linh You, Sihame Doukkali, Mélanie Hébert, Mohammadhossein Ghasempourabadi, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8694152/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version 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). Logistic regression analysis identified male sex as a significant risk factor for recurrent RD (OR = 9.89, p = 0.040). 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. scleral buckle removal recurrent retinal detachment infection anatomic success visual acuity Figures Figure 1 INTRODUCTION The placement of a scleral buckle (SB) is a common surgical procedure in the management of rhegmatogenous retinal detachment (RD). It can be used as a standalone technique or combined with pars plana vitrectomy (PPV) 1 , 2 . Occasionally, scleral buckle removal (SBR) may be required, occurring in 1% to 24% of cases 3 – 6 . Indications for SBR are diverse and include exposure, migration, infection, chronic pain, foreign body sensation, granuloma, diplopia, induced myopia and even optic nerve impingement 2 – 5 . SB infection is one of the most common reasons for removal, with regional variations in causative organisms 7 , 8 . Untreated infections may lead to severe complications including panophthalmitis and loss of the eye. The most concerning complication following SBR is the risk of recurrent RD, reported in up to 34% of cases and typically occurring within the first three months of removal 5 , 8 , 9 . Therefore, the risk-benefit ratio of SBR must be carefully considered in each case 5 . In this study, we aim to investigate the clinical indications for SBR. We also aim to assess the long-term functional and anatomic outcomes, including rate of recurrent RD and prognosis following SBR. MATERIALS & METHODS Study Design and Population This study is a retrospective, single-center analysis of all patients previously operated with combined SB and PPV that underwent a SBR at the Centre hospitalier universitaire de Québec – Université Laval between January 2008 and December 2023 with a minimum follow-up period of 1 year postoperatively. Relevant cases were identified using the Procedural Code for Scleral Buckle Removal. The study complied with the principles outlined in the Declaration of Helsinki and received approval from the Research Ethics Board of the CHU de Québec – Université Laval (Approval Number 2022–5980). Individual consent was waived due to the retrospective design and anonymous nature of the data collection. No financial support was required to conduct this study. Patients were included if they were over 18 years of age at the time of initial SB placement and underwent an SBR during the specified study period. The decision to proceed with SBR was left at the discretion of the treating surgeon based on individual patient circumstances. Comprehensive preoperative, intraoperative, and postoperative data were gathered from patient records, including baseline evaluations, intraoperative findings, and follow-up visits. Preoperative Data : Collected variables included patient age, sex, laterality of the affected eye, previous ocular history, lens status (phakic, pseudophakic, or aphakic), macula status in the initial retinal detachment (classified as “macula-on” or “macula-off”), indication for SBR and time from SB placement to SBR. Intraoperative Data : Collected intraoperative variables included fixation technique (sutures vs. tunnels), type of tamponade agent used (SF 6 , C 3 F 8 , or silicone oil), and any additional intraoperative findings. Postoperative Data : Outcomes assessed postoperatively encompassed the incidence of recurrent RD, the microbiological organisms isolated, the best-corrected visual acuity (BCVA) pre- and post- SBR, the final retina status (categorized as “retina-on” or “retina-off”), subsequent ocular surgeries, as well as the resolution of initial complaints leading to the SBR. The BCVA represented the best visual acuity recorded in the clinic using the patient’s latest refractive correction and pinhole correction, if applicable. The primary objectives of this study are to evaluate the clinical indications for SBR and to assess the rate of recurrent RD postoperatively. The secondary objectives of this study include identifying risk factors that increase the risk of having a recurrent RD and worse visual outcomes following SBR. In addition, a review of other reported cases of SBR in the literature was assessed via a systematic search of EMBASE (1947 to present). The search utilized medical subject headings (MeSH) and keywords related to SBR, with relevant terms expanded iteratively until all pertinent terms were captured. Duplicates were removed using EndNote 20.6, and Rayyan facilitated the initial title and abstract screening. The search was last updated on December 2025. Duplicates were removed using EndNote software version 8.2 (Clarivate Analytics 2018). The Web-based application Rayyan ( https://www.rayyan.ai/ ) was used to expedite the initial screening of abstracts and titles. Statistical analysis Descriptive characteristics of the sample are presented as median values with interquartile ranges (IQR) [Q 1 , Q 3 ] for continuous variables, due to their skewed distribution, which was confirmed by the Shapiro-Wilk test. Categorical variables are summarized as frequencies and percentages. Comparisons across different indications for SBR were made using chi-square tests for categorical variables and the Mann-Whitney U test or Kruskal-Wallis test for continuous variables, as appropriate. A Wilcoxon signed-rank test was conducted to compare preoperative and postoperative outcomes for non-normally distributed data. Visual acuity was treated as a continuous variable, expressed in the logarithm of the minimum angle of resolution (logMAR) scale. A Kaplan-Meier survival analysis was conducted to assess the time to SBR across different removal indications. The survival curves for each indication category were generated, and the time from SB implantation to SBR was plotted along the x-axis, with the probability of remaining without SBR on the y-axis. Log-rank tests were conducted to determine if there were statistically significant differences in time to removal between the different indications for SBR. Hazard ratios were also calculated where appropriate to quantify the relative risk of buckle removal associated with each indication category. Median survival times (the time at which 50% of patients had their buckle removed) and 95% confidence intervals were estimated for each category. Additionally, for each group, the 25th and 75th percentile survival times were reported to describe the variability in buckle retention times. All statistical analyses were performed using IBM SPSS Statistics for Mac (version 29.0.2; IBM Corp., Armonk, NY), with statistical significance defined as α = 0.05. RESULTS Patient baseline and perioperative characteristics A total of n = 2375 eyes underwent either SB or combined pars plana vitrectomy (PPV)-SB for RD during the study period. Among these, n = 35 (1.5%) eyes underwent SBR. Patients with SBR had a median [IQR] age of 62 [53, 70] years. Most patients were male (n = 24, 69%) and pseudophakic at the time of surgery (n = 25, 71%). At the time of initial RD presentation, 19 patients (55%) were classified as having either “macula-split” or “macula-off” status, while 16 patients (45%) were classified as “macula-on.” All patients had a combined PPV-SB procedure. The tamponade agents used during primary surgery included air (n = 7; 20%), SF 6 (n = 12; 34.3%), C 3 F 8 (n = 13; 37.1%) and silicone oil (n = 3; 8.6%). SB fixation technique involved horizontal mattress sutures in 29 cases (83%) and scleral tunnels in 6 cases (17%). Average preoperative BCVA was 0.68 [0.30–1.80] logMAR, which corresponds to a Snellen equivalent of 20/100. The leading reasons for SBR included infection (n = 12, 34%), pain (n = 11, 31%), strabismus (n = 3, 8.6%) and exposure without infection (n = 5, 14%). All three strabismus cases involved restrictive, inoperable vertical strabismus with either esotropia (n = 1) or exotropia (n = 2). Other causes (n = 4, 11.4%) included recurrent granuloma formation, increased IOP and/or chronic inflammation. Baseline and perioperative characteristics stratified by reason for SBR are presented in Table 1 . Table 1 Baseline characteristics and demographics of patients stratified by cause for removal of scleral buckle Characteristic, n (%), median (IQR) Infection n = 12 Intolerance n = 11 Extrusion n = 5 Others n = 4 Diplopia n = 3 p-value Age , years 68 (60–75) 61 (38–65) 68 (65–81) 54 (31–62) 57 (44–57) 0.049 Affected eye , left 4 (33%) 5 (46%) 0 (0%) 3 (75%) 1 (33%) 0.212 Sex , male 9 (75%) 3 (27%) 5 (100%) 4 (100%) 3 (100%) 0.006 Lens status Phakic 7 (58%) 10 (91%) 4 (80%) 2 (50%) 2 (67%) 0.159 Pseudophakic 5 (42%) 1 (9%) 0 (0%) 2 (50%) 1 (33%) Aphakic 0 (0%) 0 (0%) 1 (20%) 0 (0%) 0 (0%) Macula status On 4 (33%) 5 (45%) 4 (80%) 3 (75%) 0 (0%) 0.135 Off 8 (67%) 6 (55%) 1 (20%) 1 (25%) 3 (100%) Surgery type PPV-SB 12 (100%) 11 (100%) 5 (100%) 4 (100%) 3 (100%) NA SB 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Tamponade agent Air 2 (17%) 2 (18%) 2 (40%) 1 (25%) 0 (0%) 0.135 SF 6 6 (50%) 5 (46%) 0 (0%) 1 (25%) 0 (0%) C 3 F 8 4 (33%) 4 (36%) 1 (20%) 2 (50%) 2 (67%) Silicone oil 0 (0%) 0 (0%) 2 (40%) 0 (0%) 1 (33%) SB technique Sutures 3 (25%) 0 (0%) 1 (20%) 1 (25%) 0 (0%) 0.411 Scleral tunnel 9 (75%) 11 (100%) 4 (80%) 3 (75%) 3 (100%) Only sex and age distributions indicated some differences across the different reasons for SBR (p < 0.05). Post-hoc pairwise analyses indicated that patients with SBR due to infection were older than those who underwent SBR due to diplopia (p = 0.018), pain (p = 0.051) and other reasons (p = 0.058). Female patients were also more likely to have SBR for pain than for extrusion (p = 0.007), infection (p = 0.022), diplopia (p = 0.024) and other reasons (p = 0.013). None of these analyses met the criteria for significance after applying the Bonferroni correction for multiple comparisons (adjusted threshold p < 0.005). Follow-up and outcomes The average follow-up for all patients was 58.8 [26.61 to 114.81] months. The average time from SB placement to removal was 7.43 [2.1–22.7] months. Postoperative outcomes of patients stratified by cause for removal of scleral buckle are presented in Table 2 . Table 2 Postoperative outcomes of patients stratified by cause for removal of scleral buckle Characteristic, n (%), median (IQR) Infection n = 12 Intolerance n = 11 Extrusion n = 5 Others n = 4 Diplopia n = 3 p-value SB survival , months 2.4 (1.2–8.2) 20.1 (6.6–26.1) 50.7 (5.4–86.2) 4.3 (1.8–18.4) 9.7 (6.3–9.7) 0.034 Recurrence of RD 3 (25%) 2 (18%) 1 (20%) 0 (0%) 0 (0%) 0.734 Time to recurrence of RD , months 31 (14–31.5) 68.5 (24–113) N/A N/A N/A 0.304 BCVA , logMAR Pre-op SBR 0.87 (0.59–2.4) 0.37 (0.18–0.91) 0.6 (0.09–1.2) 0.79 (0.40–2.18) 2.9 (0.22–2.9) 0.306 Post-op SBR 0.38 (0.24–1.63 0.34 (0.04–0.84) 0.80 (0.075–2.1) 0.14 (0.045–0.70) 0.84 (0.040–0.84) 0.570 Change in BCVA 0.34 (-0.65-1.015) 0.080 (.017–0.28) -0.2 (-0.85–0.015) 0.44 (0.090–1.945) 2.06 (0.18–2.06) 0.609 Evisceration 1 (8.3%) 1 (9.1%) 0 (0%) 0 (0%) 0 (0%) 0.892 Total follow-up time , months 42.7 (15.2-117.4) 108 (81.1-126.4) 51.4 (20.7–80.9) 33.9 (14.9–81.4) 27.1 (26.3–36.3) 0.400 Patients with SBR for infectious causes had a significantly earlier time to buckle removal compared to non-infectious causes (2.4 [1.2–8.2] months vs. 12.6 [5.5-25.13] months) (p = 0.006). The Kaplan Meier curve is presented in Fig. 1 . SBR resolved the initial complaint in all but one case in which there was persistent neuropathic pain (n = 34/35). Average postoperative BCVA after SBR improved to 0.36 [0.10–0.99], corresponding to a Snellen equivalent of 20/40. There were no significant differences in outcomes based on reason for SBR. There were 4 (11%) cases of recurrent RD post SBR, with 3 of the cases occurring in cases where SBR was performed within the first month (median delay of 31.50 [21.50–121.50] days). Of these, 2 patients had a successful repair. The other two patients developed inoperable RD that ended in evisceration. The first case involved a patient with multiple surgeries for recurrent inferior retinal detachment complicated by macular proliferative vitreoretinopathy. Six years later, the patient opted for SBR, followed by silicone oil removal, for persistent neuralgia despite understanding the associated risks. The second case involved a patient with a presumed SB infection that rapidly progressed to orbital cellulitis and panophthalmitis, requiring urgent SBR. Both patients ultimately developed inoperable recurrent RD with severe PVR, requiring evisceration for a blind painful eye. All 12 patients with infectious SBR were treated with either systemic oral or intravenous antibiotics and topical antibiotics, including fortified antibiotics in 3 patients. Additionally, all patients received subconjunctival antibiotics perioperatively, and 1 patient received a tap and inject. Cultures were sent for 10 patients, which came out positive for Staphylococcus sp. in all cases, including for the previously described case of orbital cellulitis/ panophthalmitis. In a multiple logistic regression model for risk of recurrent RD, the only variable with significant association was being male (odds ratio: 9.89, 95% CI 1.11–86.5, p = 0.040) even after adjusting for age, duration of the SB and presence of infection. No other factors demonstrated a significant association with the risk of recurrent RD in the model ( Table 3 ). Table 3 Multiple logistic regression model for risk of recurrent RD after SBR based on baseline and perioperative characteristics. Characteristic OR 95% CI p-value Male 9.809 1.11, 86.6 0.040 Age 1.035 0.955, 1.12 0.401 Infection 3.013 0.283, 32.1 0.361 Duration of SB , months 1.019 0.97, 1.07 0.481 Fixation technique 1.05 0.93, 1.15 0.501 CI = confidence interval; SB = scleral buckle DISCUSSION This study aimed to identify the indications for SBR and evaluate outcomes, including the rate of recurrent RD following SBR. We found that infection and pain were the most common reasons for SBR, accounting for 34% and 31% of cases, respectively. These findings are consistent with previous reports indicating that infection and mechanical complications are among the most common reasons for SBR 7 , 8 , 10 , 11 . Infections leading to SBR occurred significantly earlier than non-infectious causes, as evidenced by a shorter time to buckle removal for infectious cases (median 2.4 months vs. 12.6 months, p = 0.006). Older patients were also more likely to undergo SBR for infection compared to other causes, although this relationship also did not reach the threshold for statistical significance after correction. This is expected as infectious SB require quicker treatment to prevent unfavorable outcomes including progression to panophthalmitis and even loss of the eye. Patients with infections may also experience worse outcomes due to the complications arising from the infection, rather than from the removal of the SB. We assessed the specific microbiological organisms in 10 of 12 infectious SBR cases and identified Staphylococcus sp in all samples. This finding aligns with other studies report Staphylococcus sp as the most common isolate, presumably from the patient’s skin flora. Gram-negative, acid-fast organisms and polymicrobial infections have also been documented 7 , 11 , 12 . The second most common indication for SBR was pain. The analysis of sex and age differences revealed that female patients were more likely to have SBR for pain compared to other indications such as infection, extrusion, and diplopia. In 1977, Schwartz et al reported pain as primary reason for SB removal in only 5% of patients compared to more recent studies by Le Rouic et al., 2003, Deokule et al., 2003 and Nuzzi et al., 2008 who noted pain as the main indication in 16.5%, 40% and 70% of patients respectively, with an apparent increasing trend of pain being a primary indication of removal over the decades 13 – 15 . Meanwhile, other studies did not specifically list pain as an indication, although report it in up to 88% of patients in the cohort 5 . The third most common cause was exposure. Although some studies use the term extrusion synonymously with infection, we chose to distinguish extrusion from acute signs of infection. SB extrusion is a very common indication for removal, accounting for over half of cases in recent studies 5 , 9 , 16 – 18 . Subclinical erosion may also be under-recognized, with studies reporting extrusion in up to 21.7% of postmortem eyes. Exposure or extrusion of a SB does not always require surgical removal, with some cases being observed for over a decade without deterioration 19 . The choice to remove a SB should be tailored to individual circumstances, considering factors such as patient age, existing health conditions, how symptomatic the exposed SB is and the visual status of the fellow eye 3 . The overall rate of recurrent RD following SBR in our cohort was 11%, representing 4 of 35 patients, which is consistent or slightly lower than rates reported in the literature of up to 34% 5,8,9 . In a recent study from our group, the rate of recurrent RD was 11% in patients who underwent PPV-SB, with a surgical success rate of 75% following a second surgery. Therefore, the rate of recurrent RD after SBR appears to be comparable to the expected primary success rate 20 . Additionally, only three patients underwent removal of the buckle within the first month of placement and all three patients had a recurrent RD, signifying the high risk of RD if removed early before the retina has had a chance to properly attach. Recurrent RD often also occurred in the early postoperative period, within the first three months of removal for all 4 cases. We noted a half of SBR occurred within the first 6 months of placement, while the other half occurred to up to over a decade later. This has similarly been noted by Moisseiev et al., 2017 in which a quarter of patients were operated within 6 months and the other quarter were operated after 10 years. The bimodal distribution may represent two distinct causes, with earlier cases occurring due to infection from improperly covered conjunctiva and sharp edges causing extrusion to later causes from long-term erosion of the conjunctiva 16 . On logistic regression analysis, male patients had a significantly higher risk of recurrent RD (OR = 9.89, p = 0.040), after adjusting for factors such as age, infection, and duration of SB retention. The reasons for this increased risk in males are not clear but has been supported by other studies 21 – 23 . It is thought that biological factors such as abnormal adhesions in the vitreoretinal interface and longer axial lengths seen in males may drive these increased rates of recurrence 22 . Other risk factors reported in the literature for redetachment include vitreous traction 24 , 25 , shorter duration 26 , retinal tears (as opposed to holes) and unrecognized retinal breaks 3 . Finally, the mean postoperative visual outcomes improved on average from logMAR 0.7 (Snellen equivalent of 20/100) to logMAR 0.3 (Snellen equivalent 20/40) at final follow-up (p = 0.02, Wilcoxon signed-rank test), likely reflecting proper refractive correction in the postoperative period. SBR was also considered successful in addressing the primary symptoms in most patients. Although the risk of serious complications including inoperable RD and loss of the eye, as occurred in 2 of 35 patients in the cohort, cannot be overlooked, our results suggest that removing the buckle for symptoms such as pain or infection resolves the issue without necessarily compromising visual outcomes for most patients. This encouraging finding is consistent with other reports in the literature which showed SBR was effective for symptom relief as well as clearance of infection 5 , 9 . Limitations This study has several limitations. First, the retrospective nature of the analysis introduces the potential for selection bias and missing data. We only included cases of combined PPV-SB cases in the analyses as it is rare for our center to perform standalone SB surgeries. Furthermore, there is likely be a selection bias in which only patients with combined procedures were offered SBR compared to patients with SB alone. The study was conducted at a single center, which may limit the generalizability of our findings to other populations with different clinical practices and patient demographics. Additionally, the relatively small sample size of patients undergoing SBR may limit the statistical power to detect associations, especially in subgroup analyses. For example, while our results suggest that male sex is associated with a higher risk of recurrent RD, which has also been reported in previous studies, the confidence interval is wide, and further studies with larger sample sizes are needed to confirm this finding 21 – 23 . Another limitation is the lack of standardized criteria for deciding when to perform SBR. The decision was left to the discretion of individual surgeons, which could lead to variability in timing and indications for SBR. This variability may affect outcomes and complicates the interpretation of factors associated with recurrent RD. Lastly, microbiological results were not available for all cases of SBR, and cases of extrusion without acute signs of infection were not cultured, which limits our ability to rule out subclinical infections. Future studies should aim to include more detailed microbiological data to better understand the relationship between infection and risk of complications. A summary table of other case series in the literature are included ( Table 4 ). Table 4. Review of case series on SBR in the literature Author, year Sample size Indications for SBR Recurrent RD Hilton et al., 1978 23 eyes Infection (n=7, 30%), foreign-body sensation (n=7, 30%), recurrent subconjunctival hemorrhages (n=4, 17%), impingement on the optic nerve (n=1, 4%), and distortion of the macula (n=4, 17%) n=1 (4%) Deutsch et al., 1992 61 eyes Extrusion (n=45, 74%), Infection (n=12, 20%), Diplopia (n=2, 4%), Scleritis (n=2, 4%) n=5 (8.2%) Deuokule et al., 2003 72 patients Extrusion (n=34, 47.2%), Pain (n=29, 40.2%) n=6 (8.3%) Le Rouic et al., 2003 90 eyes Diplopia (n=7, 7.7%), swelling of the buckle (n=34, 38%), extrusion (n=44, 89%), granuloma (n=5, 5.5%) n=8 (8.8%) Covert et al., 2008 / Han et al., 2013 (same cohort) 36 patients Exposure without infection (n=16, 44%), Infection without exposure (n=6, 17%), Infection with exposure (n=6, 17%), Irritation (n=6, 17%), Glaucoma (n=1, 3%), and inhibition of the growth of the eye (n=1, 3%). n=4 (12%) Nuzzi et al., 2008 43 eyes Pain (n=30, 70%), Extrusion (n=17, 40%), Conjunctivitis (n=6, 13%), Diplopia (n=4, 9%) n=0 (0%) Rasouli et al., 2014 87 eyes Extrusion (n= 66, 76%), diplopia (8%, n=7), infection (6%, n=5), a combination of extrusion and infection (6%, n=5), and Others (5%, n= 4). n=3 (3.4%) Kazi et al., 2015 102 eyes Exposure with infection (n=81, 79.4%), Exposure without infection (n=11, 10.8%), Intraocular infection (n=3, 2.9%), Anterior migration without exposure 3 (2.9), Ahmed valve placement 2 (1.9), Anterior migration with buckle exposure (n=1, 0.98%), Limitation of extraocular muscles function (n=1, 0.98%) n=7 (6.9%) Moisseiev et al., 2017 49 eyes Buckle extrusion (n=28, 57.1%), Infection (n=4, 8.2%), Both (n=1, 26.5%), Strabismus/Diplopia (n=4, 8.2%) n=4 (8.2%) Kim et al., 2020 40 eyes Exposure without infection (n=23, 57.5%), Exposure with infection (n=7, 17.5%), Elevated IOP (n=6, 15%), Strabismus/Diplopia (n=3, 7.5%), Migration of buckle material (n=1, 2.5%) n=4 (10%) Eshraghi et al., 2021 50 eyes Exposure (n=27, 54%), Infection (n=13, 26%), Diplopia (n=8, 16%), Recurrent RD (n=2, 4%) n=6 (12%) Patel et al., 2024 86 patients Exposure (n=53, 61.63%), Infection (n=18, 20.93%), Diplopia/Strabismus (n=17, 19.77%), Migration (n=13, 15.12%), Pain (n=11, 12.79%), Chronic redetachment (n=3, 3.49%), Ptosis (n=3, 3.49%) n=4 (6.56%) Our study, 2025 35 patients Infection (n=12, 34%), Pain (n=11, 31%), Extrusion (n=5, 14%), Diplopia/Strabismus (n=3, 9%), Others (n=4, 11%) n=4 (11%) CONCLUSION In conclusion, this study highlights infection and pain as the leading indications for scleral buckle removal, with infection cases requiring removal significantly earlier than non-infectious cases. Recurrent RD is a risk following SBR, particularly in male patients, and often occurs in cases that were explanted within the first month postoperatively. However, the overall rate of recurrent RD (11%) is low and comparable to the reported risk of primary RD recurrence after PPV-SB, even without undergoing a SBR 20 . Unless urgent indication such as infection is present, waiting for removal beyond the critical postoperative period is ideal. Among the measures available to the surgeon to gain time are the use of oral antibiotics to reduce inflammation and pain, as well as removal of only the most obviously infected suture when feasible. These approaches may help postpone scleral buckle removal (SBR) by several weeks or, in some cases, months. Despite these risks, visual outcomes after SBR are generally favorable, with most patients experiencing stable or even improved vision at final postoperative visit compared to the preoperative visit to the SBR. Future research should aim to validate these findings in larger, multicenter cohorts and explore additional predictors of recurrent RD following SBR. Abbreviations BCVA = best corrected visual acuity; RD = retinal detachment; SB = scleral buckle; SBR = scleral buckle removal Declarations During the preparation of this work, the authors did not use any generative artificial intelligence tools or services. All content was written, reviewed, and edited solely by the authors, who take full responsibility for the content of the publication. Funding Declaration: None available. Conflict of Interest: No conflicting relationship exists for any author. Acknowledgements: None Human Ethics and Consent to Participate Declarations : Not applicable. The study complied with the principles outlined in the Declaration of Helsinki and received approval from the Research Ethics Board of the CHU de Québec – Université Laval (Approval Number 2022-5980). Individual consent was waived due to the retrospective design and anonymous nature of the data collection. References Hosein AM, Rana S, Amir EM, Habib O, Amin N. The evaluation of ocular refractive error and axial length changes after scleral buckle removal. J Family Med Prim Care Sep. 2019;8(9):2950–2. 10.4103/jfmpc.jfmpc_557_19 . Covert DJ, Wirostko WJ, Han DP, et al. Risk factors for scleral buckle removal: a matched, case-control study. Trans Am Ophthalmol Soc. 2008;106:171–7. discussion 177-8. Tsui I. Scleral buckle removal: indications and outcomes. Surv Ophthalmol . May-Jun. 2012;57(3):253–63. 10.1016/j.survophthal.2011.11.001 . Hilton GF, Wallyn RH. The removal of scleral buckles. Arch Ophthalmol Nov. 1978;96(11):2061–3. 10.1001/archopht.1978.03910060449011 . Han DP, Covert DJ, Wirostko WJ, Hammersley JA, Lindgren KE. SCLERAL BUCKLE REMOVAL IN THE VITRECTOMY ERA: A 20-Year Clinical Experience. RETINA. 2013;33(2). Deutsch J, Aggarwal RK, Eagling EM. Removal of scleral explant elements: a 10-year retrospective study. Eye (Lond). 1992;6(Pt 6):570–3. 10.1038/eye.1992.124 . Chhablani J, Nayak S, Jindal A, et al. Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility. J Ophthalmic Inflamm Infect Dec. 2013;13(1):67. 10.1186/1869-5760-3-67 . Ulrich RA, Burton TC. Infections Following Scleral Buckling Procedures. Arch Ophthalmol. 1974;92(3):213–5. 10.1001/archopht.1974.01010010221007 . Patel P, Heo JY, Shepherd EA, Chaturvedi V. Scleral Buckle Removal: Long-Term Patient Outcomes. Ophthalmol Retina Jan. 2024;8(1):3–9. 10.1016/j.oret.2023.07.029 . Kazi MS, Sharma VR, Kumar S, Bhende P. Indications and outcomes of scleral buckle removal in a tertiary eye care center in South India. Oman J Ophthalmol. 2015;8(3). Kazi MS, Sharma VR, Kumar S, Bhende P. Indications and outcomes of scleral buckle removal in a tertiary eye care center in South India. Oman J Ophthalmol Sep-Dec. 2015;8(3):171–4. 10.4103/0974-620x.169891 . Pathengay A, Karosekar S, Raju B, Sharma S, Das T. Microbiologic spectrum and susceptibility of isolates in scleral buckle infection in India. Am J Ophthalmol Oct. 2004;138(4):663–4. 10.1016/j.ajo.2004.04.056 . Nuzzi G, Rossi S. Buckle removal in retinal detachment surgery: a consecutive case series. Acta Bio-medica: Atenei Parmensis. 2008;79(2):128–32. Deokule S, Reginald A, Callear A. Scleral explant removal: the last decade. Eye. 2003;17(6):697–700. Le Rouic JF, Bettembourg O, D'Hermies F, Azan F, Renard G, Chauvaud D. Late swelling and removal of Miragel buckles: a comparison with silicone indentations. Retina Oct. 2003;23(5):641–6. 10.1097/00006982-200310000-00006 . Moisseiev E, Fogel M, Fabian ID, Barak A, Moisseiev J, Alhalel A. Outcomes of Scleral Buckle Removal: Experience from the Last Decade. Curr Eye Res May. 2017;42(5):766–70. 10.1080/02713683.2016.1245423 . Kim KW, Park UC, Yu HG. Recurrence of Retinal Detachment after Scleral Buckle Removal. Korean J Ophthalmol Dec. 2020;34(6):454–61. 10.3341/kjo.2020.0099 . Eshraghi H, Prenner JL, Zhang R, et al. Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes. Ophthalmic Surg Lasers Imaging Retina Mar. 2021;52(3):138–44. 10.3928/23258160-20210302-04 . Schmidt CW, Cohen HB. Exposed scleral buckle: a case report in an eleven-year course. Ophthalmic Surg Mar. 1983;14(3):238–9. Hébert M, Garneau J, Doukkali S, et al. Outcomes in Recurrent Rhegmatogenous Retinal Detachment Repair: Does Scleral Buckling at Primary or Secondary Surgery Impact Results? Clin Ophthalmol. 2025;19:949–56. 10.2147/opth.S507985 . Irigoyen C, Goikoetxea-Zubeldia A, Sanchez-Molina J, Amenabar Alonso A, Ruiz-Miguel M, Iglesias-Gaspar MT. Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain. J Clin Med Aug. 2022;4(15). 10.3390/jcm11154551 . Callaway NF, Vail D, Al-Moujahed A, et al. Sex differences in the repair of retinal detachments in the United States. Am J Ophthalmol. 2020;219:284–94. Gerstenberger E, Stoffelns B, Nickels S, et al. Incidence of Retinal Detachment in Germany: Results from the Gutenberg Health Study. Ophthalmologica. 2021;244(2):133–40. 10.1159/000513080 . Lindsey PS, Pierce LH, Welch RB. Removal of Scleral Buckling Elements: Causes and Complications. Arch Ophthalmol. 1983;101(4):570–3. 10.1001/archopht.1983.01040010570007 . Zhioua R, Ammous I, Errais K, et al. Frequency, characteristics, and risk factors of late recurrence of retinal detachment. Eur J Ophthalmol Nov-Dec. 2008;18(6):960–4. 10.1177/112067210801800617 . Schwartz PL, Pruett RC. Factors Influencing Retinal Redetachment After Removal of Buckling Elements. Arch Ophthalmol. 1977;95(5):804–7. 10.1001/archopht.1977.04450050082007 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8694152","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589166703,"identity":"3f13408a-123a-414c-85d5-98ca2e31169d","order_by":0,"name":"Eunice Linh You","email":"","orcid":"","institution":"Moorfields Eye Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Eunice","middleName":"Linh","lastName":"You","suffix":""},{"id":589166705,"identity":"c9aab67a-824b-4a04-b5c1-47b72f581c1f","order_by":1,"name":"Sihame Doukkali","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Sihame","middleName":"","lastName":"Doukkali","suffix":""},{"id":589166707,"identity":"afef1848-dad9-42b5-b479-6d2d4e547a6e","order_by":2,"name":"Mélanie Hébert","email":"","orcid":"","institution":"National Eye Institute","correspondingAuthor":false,"prefix":"","firstName":"Mélanie","middleName":"","lastName":"Hébert","suffix":""},{"id":589166709,"identity":"20fbbd07-7248-4b02-95fe-66bd6fd470b7","order_by":3,"name":"Mohammadhossein Ghasempourabadi","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Mohammadhossein","middleName":"","lastName":"Ghasempourabadi","suffix":""},{"id":589166712,"identity":"bb254f5a-6d03-46b1-8971-383fb2941af0","order_by":4,"name":"Kelvin You","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Kelvin","middleName":"","lastName":"You","suffix":""},{"id":589166715,"identity":"a80a8eca-b40d-4f85-af31-fafd9cb9f22a","order_by":5,"name":"David Jin","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Jin","suffix":""},{"id":589166717,"identity":"a783c860-6118-491a-a932-d12bc985ef27","order_by":6,"name":"Serge Bourgault","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Serge","middleName":"","lastName":"Bourgault","suffix":""},{"id":589166718,"identity":"d9b01fad-cc9a-431d-82ae-041e4174fc89","order_by":7,"name":"Mathieu Caissie","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Mathieu","middleName":"","lastName":"Caissie","suffix":""},{"id":589166719,"identity":"6099c550-9d00-4e27-bfba-a88f1799d1f2","order_by":8,"name":"Éric Tourville","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Éric","middleName":"","lastName":"Tourville","suffix":""},{"id":589166720,"identity":"87cd268f-0071-4f29-aede-7220e84dcb18","order_by":9,"name":"Ali Dirani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYDCCAwwGB4AUDz+Ik1BAihbJBpAWAyK1gGmwRgZitPDdPrzxcEXNHRnj86sTPzwwYJDnFzuAX4vkubSCg2eOPeMxu/F2swTQYYYzZyfg12JwhsfgYAPbYaCWsxtAWhIMbhOl5d9hHuMZZzf/IF5LY9thHgP+3m3E2SJ5hq3gYGPfYR6JG7zbLBIMJAj7he8M8+aPDd8O2/P3n91880eFjTy/NAEtCCABVilBrHIQ4D9AiupRMApGwSgYSQAAPqZJtu3it98AAAAASUVORK5CYII=","orcid":"","institution":"Université Laval","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"","lastName":"Dirani","suffix":""}],"badges":[],"createdAt":"2026-01-25 17:54:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8694152/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8694152/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102441385,"identity":"8df57b60-feac-484e-a2df-b932d3f2eef0","added_by":"auto","created_at":"2026-02-11 16:55:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82609,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan Meier survival curve showing the time to removal of scleral buckle based on infection status\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8694152/v1/0f8a2cb0bddcc1f698026572.png"},{"id":102441389,"identity":"3c4e4c1d-6bf3-4e2e-8b55-70075a5f9882","added_by":"auto","created_at":"2026-02-11 16:55:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1003562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8694152/v1/1c9c669a-e049-4875-aa33-5b80628edb09.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Removal of scleral buckle: indications, long-term outcomes and comparison with the literature","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe placement of a scleral buckle (SB) is a common surgical procedure in the management of rhegmatogenous retinal detachment (RD). It can be used as a standalone technique or combined with pars plana vitrectomy (PPV)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Occasionally, scleral buckle removal (SBR) may be required, occurring in 1% to 24% of cases \u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIndications for SBR are diverse and include exposure, migration, infection, chronic pain, foreign body sensation, granuloma, diplopia, induced myopia and even optic nerve impingement \u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. SB infection is one of the most common reasons for removal, with regional variations in causative organisms \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Untreated infections may lead to severe complications including panophthalmitis and loss of the eye.\u003c/p\u003e \u003cp\u003eThe most concerning complication following SBR is the risk of recurrent RD, reported in up to 34% of cases and typically occurring within the first three months of removal \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Therefore, the risk-benefit ratio of SBR must be carefully considered in each case \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, we aim to investigate the clinical indications for SBR. We also aim to assess the long-term functional and anatomic outcomes, including rate of recurrent RD and prognosis following SBR.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Population\u003c/h2\u003e \u003cp\u003eThis study is a retrospective, single-center analysis of all patients previously operated with combined SB and PPV that underwent a SBR at the Centre hospitalier universitaire de Qu\u0026eacute;bec \u0026ndash; Universit\u0026eacute; Laval between January 2008 and December 2023 with a minimum follow-up period of 1 year postoperatively. Relevant cases were identified using the Procedural Code for Scleral Buckle Removal. The study complied with the principles outlined in the Declaration of Helsinki and received approval from the Research Ethics Board of the CHU de Qu\u0026eacute;bec \u0026ndash; Universit\u0026eacute; Laval (Approval Number 2022\u0026ndash;5980). Individual consent was waived due to the retrospective design and anonymous nature of the data collection. No financial support was required to conduct this study.\u003c/p\u003e \u003cp\u003ePatients were included if they were over 18 years of age at the time of initial SB placement and underwent an SBR during the specified study period. The decision to proceed with SBR was left at the discretion of the treating surgeon based on individual patient circumstances.\u003c/p\u003e \u003cp\u003eComprehensive preoperative, intraoperative, and postoperative data were gathered from patient records, including baseline evaluations, intraoperative findings, and follow-up visits.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ePreoperative Data\u003c/em\u003e: Collected variables included patient age, sex, laterality of the affected eye, previous ocular history, lens status (phakic, pseudophakic, or aphakic), macula status in the initial retinal detachment (classified as \u0026ldquo;macula-on\u0026rdquo; or \u0026ldquo;macula-off\u0026rdquo;), indication for SBR and time from SB placement to SBR.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eIntraoperative Data\u003c/em\u003e: Collected intraoperative variables included fixation technique (sutures vs. tunnels), type of tamponade agent used (SF\u003csub\u003e6\u003c/sub\u003e, C\u003csub\u003e3\u003c/sub\u003eF\u003csub\u003e8\u003c/sub\u003e, or silicone oil), and any additional intraoperative findings.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ePostoperative Data\u003c/em\u003e: Outcomes assessed postoperatively encompassed the incidence of recurrent RD, the microbiological organisms isolated, the best-corrected visual acuity (BCVA) pre- and post- SBR, the final retina status (categorized as \u0026ldquo;retina-on\u0026rdquo; or \u0026ldquo;retina-off\u0026rdquo;), subsequent ocular surgeries, as well as the resolution of initial complaints leading to the SBR. The BCVA represented the best visual acuity recorded in the clinic using the patient\u0026rsquo;s latest refractive correction and pinhole correction, if applicable.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe primary objectives of this study are to evaluate the clinical indications for SBR and to assess the rate of recurrent RD postoperatively. The secondary objectives of this study include identifying risk factors that increase the risk of having a recurrent RD and worse visual outcomes following SBR.\u003c/p\u003e \u003cp\u003eIn addition, a review of other reported cases of SBR in the literature was assessed via a systematic search of EMBASE (1947 to present). The search utilized medical subject headings (MeSH) and keywords related to SBR, with relevant terms expanded iteratively until all pertinent terms were captured. Duplicates were removed using EndNote 20.6, and Rayyan facilitated the initial title and abstract screening. The search was last updated on December 2025. Duplicates were removed using EndNote software version 8.2 (Clarivate Analytics 2018). The Web-based application Rayyan (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rayyan.ai/\u003c/span\u003e\u003cspan address=\"https://www.rayyan.ai/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to expedite the initial screening of abstracts and titles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive characteristics of the sample are presented as median values with interquartile ranges (IQR) [Q\u003csub\u003e1\u003c/sub\u003e, Q\u003csub\u003e3\u003c/sub\u003e] for continuous variables, due to their skewed distribution, which was confirmed by the Shapiro-Wilk test. Categorical variables are summarized as frequencies and percentages. Comparisons across different indications for SBR were made using chi-square tests for categorical variables and the Mann-Whitney U test or Kruskal-Wallis test for continuous variables, as appropriate. A Wilcoxon signed-rank test was conducted to compare preoperative and postoperative outcomes for non-normally distributed data. Visual acuity was treated as a continuous variable, expressed in the logarithm of the minimum angle of resolution (logMAR) scale.\u003c/p\u003e \u003cp\u003eA Kaplan-Meier survival analysis was conducted to assess the time to SBR across different removal indications. The survival curves for each indication category were generated, and the time from SB implantation to SBR was plotted along the x-axis, with the probability of remaining without SBR on the y-axis. Log-rank tests were conducted to determine if there were statistically significant differences in time to removal between the different indications for SBR. Hazard ratios were also calculated where appropriate to quantify the relative risk of buckle removal associated with each indication category.\u003c/p\u003e \u003cp\u003eMedian survival times (the time at which 50% of patients had their buckle removed) and 95% confidence intervals were estimated for each category. Additionally, for each group, the 25th and 75th percentile survival times were reported to describe the variability in buckle retention times. All statistical analyses were performed using IBM SPSS Statistics for Mac (version 29.0.2; IBM Corp., Armonk, NY), with statistical significance defined as α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatient baseline and perioperative characteristics\u003c/h2\u003e \u003cp\u003eA total of n\u0026thinsp;=\u0026thinsp;2375 eyes underwent either SB or combined pars plana vitrectomy (PPV)-SB for RD during the study period. Among these, n\u0026thinsp;=\u0026thinsp;35 (1.5%) eyes underwent SBR.\u003c/p\u003e \u003cp\u003ePatients with SBR had a median [IQR] age of 62 [53, 70] years. Most patients were male (n\u0026thinsp;=\u0026thinsp;24, 69%) and pseudophakic at the time of surgery (n\u0026thinsp;=\u0026thinsp;25, 71%). At the time of initial RD presentation, 19 patients (55%) were classified as having either \u0026ldquo;macula-split\u0026rdquo; or \u0026ldquo;macula-off\u0026rdquo; status, while 16 patients (45%) were classified as \u0026ldquo;macula-on.\u0026rdquo; All patients had a combined PPV-SB procedure. The tamponade agents used during primary surgery included air (n\u0026thinsp;=\u0026thinsp;7; 20%), SF\u003csub\u003e6\u003c/sub\u003e (n\u0026thinsp;=\u0026thinsp;12; 34.3%), C\u003csub\u003e3\u003c/sub\u003eF\u003csub\u003e8\u003c/sub\u003e (n\u0026thinsp;=\u0026thinsp;13; 37.1%) and silicone oil (n\u0026thinsp;=\u0026thinsp;3; 8.6%). SB fixation technique involved horizontal mattress sutures in 29 cases (83%) and scleral tunnels in 6 cases (17%). Average preoperative BCVA was 0.68 [0.30\u0026ndash;1.80] logMAR, which corresponds to a Snellen equivalent of 20/100.\u003c/p\u003e \u003cp\u003eThe leading reasons for SBR included infection (n\u0026thinsp;=\u0026thinsp;12, 34%), pain (n\u0026thinsp;=\u0026thinsp;11, 31%), strabismus (n\u0026thinsp;=\u0026thinsp;3, 8.6%) and exposure without infection (n\u0026thinsp;=\u0026thinsp;5, 14%). All three strabismus cases involved restrictive, inoperable vertical strabismus with either esotropia (n\u0026thinsp;=\u0026thinsp;1) or exotropia (n\u0026thinsp;=\u0026thinsp;2). Other causes (n\u0026thinsp;=\u0026thinsp;4, 11.4%) included recurrent granuloma formation, increased IOP and/or chronic inflammation. Baseline and perioperative characteristics stratified by reason for SBR are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics and demographics of patients stratified by cause for removal of scleral buckle\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic, n (%), median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntolerance\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExtrusion\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiplopia\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, \u003cb\u003eyears\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (60\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (38\u0026ndash;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (65\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (31\u0026ndash;62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (44\u0026ndash;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAffected eye\u003c/b\u003e, \u003cb\u003eleft\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e, \u003cb\u003emale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLens status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudophakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMacula status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPV-SB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTamponade agent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSF\u003csub\u003e6\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003csub\u003e3\u003c/sub\u003eF\u003csub\u003e8\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilicone oil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSB technique\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSutures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScleral tunnel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly sex and age distributions indicated some differences across the different reasons for SBR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Post-hoc pairwise analyses indicated that patients with SBR due to infection were older than those who underwent SBR due to diplopia (p\u0026thinsp;=\u0026thinsp;0.018), pain (p\u0026thinsp;=\u0026thinsp;0.051) and other reasons (p\u0026thinsp;=\u0026thinsp;0.058). Female patients were also more likely to have SBR for pain than for extrusion (p\u0026thinsp;=\u0026thinsp;0.007), infection (p\u0026thinsp;=\u0026thinsp;0.022), diplopia (p\u0026thinsp;=\u0026thinsp;0.024) and other reasons (p\u0026thinsp;=\u0026thinsp;0.013). None of these analyses met the criteria for significance after applying the Bonferroni correction for multiple comparisons (adjusted threshold p\u0026thinsp;\u0026lt;\u0026thinsp;0.005).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFollow-up and outcomes\u003c/h3\u003e\n\u003cp\u003eThe average follow-up for all patients was 58.8 [26.61 to 114.81] months. The average time from SB placement to removal was 7.43 [2.1\u0026ndash;22.7] months. Postoperative outcomes of patients stratified by cause for removal of scleral buckle are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative outcomes of patients stratified by cause for removal of scleral buckle\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic, n (%), median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntolerance\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExtrusion\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiplopia\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSB survival\u003c/b\u003e, \u003cb\u003emonths\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4 (1.2\u0026ndash;8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.1 (6.6\u0026ndash;26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7 (5.4\u0026ndash;86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3 (1.8\u0026ndash;18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.7 (6.3\u0026ndash;9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence of RD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to recurrence of RD\u003c/b\u003e, \u003cb\u003emonths\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (14\u0026ndash;31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.5 (24\u0026ndash;113)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBCVA\u003c/b\u003e, \u003cb\u003elogMAR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op SBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87 (0.59\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.37 (0.18\u0026ndash;0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6 (0.09\u0026ndash;1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 (0.40\u0026ndash;2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9 (0.22\u0026ndash;2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op SBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38 (0.24\u0026ndash;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.34 (0.04\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 (0.075\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14 (0.045\u0026ndash;0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84 (0.040\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in BCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.34 (-0.65-1.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.080 (.017\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.2 (-0.85\u0026ndash;0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44 (0.090\u0026ndash;1.945)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.06 (0.18\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvisceration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal follow-up time\u003c/b\u003e, \u003cb\u003emonths\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.7 (15.2-117.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (81.1-126.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.4 (20.7\u0026ndash;80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.9 (14.9\u0026ndash;81.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.1 (26.3\u0026ndash;36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients with SBR for infectious causes had a significantly earlier time to buckle removal compared to non-infectious causes (2.4 [1.2\u0026ndash;8.2] months vs. 12.6 [5.5-25.13] months) (p\u0026thinsp;=\u0026thinsp;0.006). The Kaplan Meier curve is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. SBR resolved the initial complaint in all but one case in which there was persistent neuropathic pain (n\u0026thinsp;=\u0026thinsp;34/35). Average postoperative BCVA after SBR improved to 0.36 [0.10\u0026ndash;0.99], corresponding to a Snellen equivalent of 20/40. There were no significant differences in outcomes based on reason for SBR.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere were 4 (11%) cases of recurrent RD post SBR, with 3 of the cases occurring in cases where SBR was performed within the first month (median delay of 31.50 [21.50\u0026ndash;121.50] days). Of these, 2 patients had a successful repair. The other two patients developed inoperable RD that ended in evisceration. The first case involved a patient with multiple surgeries for recurrent inferior retinal detachment complicated by macular proliferative vitreoretinopathy. Six years later, the patient opted for SBR, followed by silicone oil removal, for persistent neuralgia despite understanding the associated risks. The second case involved a patient with a presumed SB infection that rapidly progressed to orbital cellulitis and panophthalmitis, requiring urgent SBR. Both patients ultimately developed inoperable recurrent RD with severe PVR, requiring evisceration for a blind painful eye.\u003c/p\u003e \u003cp\u003eAll 12 patients with infectious SBR were treated with either systemic oral or intravenous antibiotics and topical antibiotics, including fortified antibiotics in 3 patients. Additionally, all patients received subconjunctival antibiotics perioperatively, and 1 patient received a tap and inject. Cultures were sent for 10 patients, which came out positive for \u003cem\u003eStaphylococcus sp.\u003c/em\u003e in all cases, including for the previously described case of orbital cellulitis/ panophthalmitis.\u003c/p\u003e \u003cp\u003eIn a multiple logistic regression model for risk of recurrent RD, the only variable with significant association was being male (odds ratio: 9.89, 95% CI 1.11\u0026ndash;86.5, p\u0026thinsp;=\u0026thinsp;0.040) even after adjusting for age, duration of the SB and presence of infection. No other factors demonstrated a significant association with the risk of recurrent RD in the model \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple logistic regression model for risk of recurrent RD after SBR based on baseline and perioperative characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.11, 86.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.955, 1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.283, 32.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of SB\u003c/b\u003e, \u003cb\u003emonths\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97, 1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFixation technique\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93, 1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; SB\u0026thinsp;=\u0026thinsp;scleral buckle\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to identify the indications for SBR and evaluate outcomes, including the rate of recurrent RD following SBR. We found that infection and pain were the most common reasons for SBR, accounting for 34% and 31% of cases, respectively. These findings are consistent with previous reports indicating that infection and mechanical complications are among the most common reasons for SBR \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Infections leading to SBR occurred significantly earlier than non-infectious causes, as evidenced by a shorter time to buckle removal for infectious cases (median 2.4 months vs. 12.6 months, p\u0026thinsp;=\u0026thinsp;0.006). Older patients were also more likely to undergo SBR for infection compared to other causes, although this relationship also did not reach the threshold for statistical significance after correction. This is expected as infectious SB require quicker treatment to prevent unfavorable outcomes including progression to panophthalmitis and even loss of the eye. Patients with infections may also experience worse outcomes due to the complications arising from the infection, rather than from the removal of the SB.\u003c/p\u003e \u003cp\u003eWe assessed the specific microbiological organisms in 10 of 12 infectious SBR cases and identified \u003cem\u003eStaphylococcus sp\u003c/em\u003e in all samples. This finding aligns with other studies report \u003cem\u003eStaphylococcus sp\u003c/em\u003e as the most common isolate, presumably from the patient\u0026rsquo;s skin flora. Gram-negative, acid-fast organisms and polymicrobial infections have also been documented \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe second most common indication for SBR was pain. The analysis of sex and age differences revealed that female patients were more likely to have SBR for pain compared to other indications such as infection, extrusion, and diplopia. In 1977, Schwartz et al reported pain as primary reason for SB removal in only 5% of patients compared to more recent studies by Le Rouic et al., 2003, Deokule et al., 2003 and Nuzzi et al., 2008 who noted pain as the main indication in 16.5%, 40% and 70% of patients respectively, with an apparent increasing trend of pain being a primary indication of removal over the decades \u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Meanwhile, other studies did not specifically list pain as an indication, although report it in up to 88% of patients in the cohort \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe third most common cause was exposure. Although some studies use the term extrusion synonymously with infection, we chose to distinguish extrusion from acute signs of infection. SB extrusion is a very common indication for removal, accounting for over half of cases in recent studies \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Subclinical erosion may also be under-recognized, with studies reporting extrusion in up to 21.7% of postmortem eyes.\u003c/p\u003e \u003cp\u003eExposure or extrusion of a SB does not always require surgical removal, with some cases being observed for over a decade without deterioration \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The choice to remove a SB should be tailored to individual circumstances, considering factors such as patient age, existing health conditions, how symptomatic the exposed SB is and the visual status of the fellow eye \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe overall rate of recurrent RD following SBR in our cohort was 11%, representing 4 of 35 patients, which is consistent or slightly lower than rates reported in the literature of up to 34% \u003csup\u003e5,8,9\u003c/sup\u003e. In a recent study from our group, the rate of recurrent RD was 11% in patients who underwent PPV-SB, with a surgical success rate of 75% following a second surgery. Therefore, the rate of recurrent RD after SBR appears to be comparable to the expected primary success rate \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdditionally, only three patients underwent removal of the buckle within the first month of placement and all three patients had a recurrent RD, signifying the high risk of RD if removed early before the retina has had a chance to properly attach. Recurrent RD often also occurred in the early postoperative period, within the first three months of removal for all 4 cases. We noted a half of SBR occurred within the first 6 months of placement, while the other half occurred to up to over a decade later. This has similarly been noted by Moisseiev et al., 2017 in which a quarter of patients were operated within 6 months and the other quarter were operated after 10 years. The bimodal distribution may represent two distinct causes, with earlier cases occurring due to infection from improperly covered conjunctiva and sharp edges causing extrusion to later causes from long-term erosion of the conjunctiva \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOn logistic regression analysis, male patients had a significantly higher risk of recurrent RD (OR\u0026thinsp;=\u0026thinsp;9.89, p\u0026thinsp;=\u0026thinsp;0.040), after adjusting for factors such as age, infection, and duration of SB retention. The reasons for this increased risk in males are not clear but has been supported by other studies \u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. It is thought that biological factors such as abnormal adhesions in the vitreoretinal interface and longer axial lengths seen in males may drive these increased rates of recurrence \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Other risk factors reported in the literature for redetachment include vitreous traction \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, shorter duration \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, retinal tears (as opposed to holes) and unrecognized retinal breaks \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFinally, the mean postoperative visual outcomes improved on average from logMAR 0.7 (Snellen equivalent of 20/100) to logMAR 0.3 (Snellen equivalent 20/40) at final follow-up (p\u0026thinsp;=\u0026thinsp;0.02, Wilcoxon signed-rank test), likely reflecting proper refractive correction in the postoperative period. SBR was also considered successful in addressing the primary symptoms in most patients. Although the risk of serious complications including inoperable RD and loss of the eye, as occurred in 2 of 35 patients in the cohort, cannot be overlooked, our results suggest that removing the buckle for symptoms such as pain or infection resolves the issue without necessarily compromising visual outcomes for most patients. This encouraging finding is consistent with other reports in the literature which showed SBR was effective for symptom relief as well as clearance of infection \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, the retrospective nature of the analysis introduces the potential for selection bias and missing data. We only included cases of combined PPV-SB cases in the analyses as it is rare for our center to perform standalone SB surgeries. Furthermore, there is likely be a selection bias in which only patients with combined procedures were offered SBR compared to patients with SB alone. The study was conducted at a single center, which may limit the generalizability of our findings to other populations with different clinical practices and patient demographics. Additionally, the relatively small sample size of patients undergoing SBR may limit the statistical power to detect associations, especially in subgroup analyses. For example, while our results suggest that male sex is associated with a higher risk of recurrent RD, which has also been reported in previous studies, the confidence interval is wide, and further studies with larger sample sizes are needed to confirm this finding \u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAnother limitation is the lack of standardized criteria for deciding when to perform SBR. The decision was left to the discretion of individual surgeons, which could lead to variability in timing and indications for SBR. This variability may affect outcomes and complicates the interpretation of factors associated with recurrent RD.\u003c/p\u003e \u003cp\u003eLastly, microbiological results were not available for all cases of SBR, and cases of extrusion without acute signs of infection were not cultured, which limits our ability to rule out subclinical infections. Future studies should aim to include more detailed microbiological data to better understand the relationship between infection and risk of complications.\u003c/p\u003e \u003cp\u003eA summary table of other case series in the literature are included \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Review of case series on SBR in the literature\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor, year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndications for SBR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRecurrent RD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eHilton et al., 1978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e23 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eInfection (n=7, 30%), foreign-body sensation (n=7, 30%), recurrent subconjunctival hemorrhages (n=4, 17%), impingement on the optic nerve (n=1, 4%), and distortion of the macula (n=4, 17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=1 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eDeutsch et al., 1992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e61 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExtrusion (n=45, 74%), Infection (n=12, 20%), Diplopia (n=2, 4%), Scleritis (n=2, 4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=5 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eDeuokule et al., 2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e72 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExtrusion (n=34, 47.2%), Pain (n=29, 40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=6 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eLe Rouic et al., 2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e90 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eDiplopia (n=7, 7.7%), swelling of the buckle (n=34, 38%), extrusion (n=44, 89%), granuloma (n=5, 5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=8 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCovert et al., 2008 / Han et al., 2013 (same cohort)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e36 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExposure without infection (n=16, 44%), Infection without exposure (n=6, 17%), Infection with exposure (n=6, 17%), Irritation (n=6, 17%), Glaucoma (n=1, 3%), and inhibition of the growth of the eye (n=1, 3%).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=4 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNuzzi et al., 2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e43 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003ePain (n=30, 70%), Extrusion (n=17, 40%), Conjunctivitis (n=6, 13%), Diplopia (n=4, 9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eRasouli et al., 2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e87 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExtrusion (n= 66, 76%), diplopia (8%, n=7), infection (6%, n=5), a combination of extrusion and infection (6%, n=5), and Others (5%, n= 4).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=3 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eKazi et al., 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e102 eyes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExposure with infection (n=81, 79.4%), Exposure without infection (n=11, 10.8%), Intraocular infection (n=3, 2.9%), Anterior migration without exposure 3 (2.9), Ahmed valve placement 2 (1.9), Anterior migration with buckle exposure \u0026nbsp;(n=1, 0.98%), Limitation of extraocular muscles function (n=1, 0.98%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=7 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMoisseiev et al., 2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e49 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eBuckle extrusion (n=28, 57.1%), Infection (n=4, 8.2%), Both (n=1, 26.5%), Strabismus/Diplopia (n=4, 8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=4 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eKim et al., 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e40 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExposure without infection (n=23, 57.5%), Exposure with infection (n=7, 17.5%), Elevated IOP (n=6, 15%), Strabismus/Diplopia (n=3, 7.5%), Migration of buckle material (n=1, 2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=4 (10%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eEshraghi et al., 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e50 eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExposure (n=27, 54%), Infection (n=13, 26%), Diplopia (n=8, 16%), Recurrent RD (n=2, 4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=6 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePatel et al., 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e86 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eExposure (n=53, 61.63%), Infection (n=18, 20.93%), Diplopia/Strabismus (n=17, 19.77%), Migration (n=13, 15.12%), Pain (n=11, 12.79%), Chronic redetachment (n=3, 3.49%), Ptosis (n=3, 3.49%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=4 (6.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOur study, 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8276%;\"\u003e\n \u003cp\u003e35 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.5009%;\"\u003e\n \u003cp\u003eInfection (n=12, 34%), Pain (n=11, 31%), Extrusion (n=5, 14%), Diplopia/Strabismus (n=3, 9%), Others (n=4, 11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7782%;\"\u003e\n \u003cp\u003en=4 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this study highlights infection and pain as the leading indications for scleral buckle removal, with infection cases requiring removal significantly earlier than non-infectious cases. Recurrent RD is a risk following SBR, particularly in male patients, and often occurs in cases that were explanted within the first month postoperatively. However, the overall rate of recurrent RD (11%) is low and comparable to the reported risk of primary RD recurrence after PPV-SB, even without undergoing a SBR \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Unless urgent indication such as infection is present, waiting for removal beyond the critical postoperative period is ideal. Among the measures available to the surgeon to gain time are the use of oral antibiotics to reduce inflammation and pain, as well as removal of only the most obviously infected suture when feasible. These approaches may help postpone scleral buckle removal (SBR) by several weeks or, in some cases, months. Despite these risks, visual outcomes after SBR are generally favorable, with most patients experiencing stable or even improved vision at final postoperative visit compared to the preoperative visit to the SBR.\u003c/p\u003e \u003cp\u003eFuture research should aim to validate these findings in larger, multicenter cohorts and explore additional predictors of recurrent RD following SBR.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eBCVA\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;best corrected visual acuity; RD\u0026thinsp;=\u0026thinsp;retinal detachment; SB\u0026thinsp;=\u0026thinsp;scleral buckle; SBR\u0026thinsp;=\u0026thinsp;scleral buckle removal\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDuring the preparation of this work, the authors did not use any generative artificial intelligence tools or services. All content was written, reviewed, and edited solely by the authors, who take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e None available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e No conflicting relationship exists for any author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declarations :\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study complied with the principles outlined in the Declaration of Helsinki and received approval from the Research Ethics Board of the CHU de Qu\u0026eacute;bec \u0026ndash; Universit\u0026eacute; Laval (Approval Number 2022-5980). Individual consent was waived due to the retrospective design and anonymous nature of the data collection.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHosein AM, Rana S, Amir EM, Habib O, Amin N. The evaluation of ocular refractive error and axial length changes after scleral buckle removal. J Family Med Prim Care Sep. 2019;8(9):2950\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jfmpc.jfmpc_557_19\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_557_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCovert DJ, Wirostko WJ, Han DP, et al. Risk factors for scleral buckle removal: a matched, case-control study. Trans Am Ophthalmol Soc. 2008;106:171\u0026ndash;7. discussion 177-8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsui I. Scleral buckle removal: indications and outcomes. \u003cem\u003eSurv Ophthalmol\u003c/em\u003e. May-Jun. 2012;57(3):253\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.survophthal.2011.11.001\u003c/span\u003e\u003cspan address=\"10.1016/j.survophthal.2011.11.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHilton GF, Wallyn RH. The removal of scleral buckles. Arch Ophthalmol Nov. 1978;96(11):2061\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.1978.03910060449011\u003c/span\u003e\u003cspan address=\"10.1001/archopht.1978.03910060449011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan DP, Covert DJ, Wirostko WJ, Hammersley JA, Lindgren KE. SCLERAL BUCKLE REMOVAL IN THE VITRECTOMY ERA: A 20-Year Clinical Experience. RETINA. 2013;33(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeutsch J, Aggarwal RK, Eagling EM. Removal of scleral explant elements: a 10-year retrospective study. Eye (Lond). 1992;6(Pt 6):570\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/eye.1992.124\u003c/span\u003e\u003cspan address=\"10.1038/eye.1992.124\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChhablani J, Nayak S, Jindal A, et al. Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility. J Ophthalmic Inflamm Infect Dec. 2013;13(1):67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1869-5760-3-67\u003c/span\u003e\u003cspan address=\"10.1186/1869-5760-3-67\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlrich RA, Burton TC. Infections Following Scleral Buckling Procedures. Arch Ophthalmol. 1974;92(3):213\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.1974.01010010221007\u003c/span\u003e\u003cspan address=\"10.1001/archopht.1974.01010010221007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel P, Heo JY, Shepherd EA, Chaturvedi V. Scleral Buckle Removal: Long-Term Patient Outcomes. Ophthalmol Retina Jan. 2024;8(1):3\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.oret.2023.07.029\u003c/span\u003e\u003cspan address=\"10.1016/j.oret.2023.07.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazi MS, Sharma VR, Kumar S, Bhende P. Indications and outcomes of scleral buckle removal in a tertiary eye care center in South India. Oman J Ophthalmol. 2015;8(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazi MS, Sharma VR, Kumar S, Bhende P. Indications and outcomes of scleral buckle removal in a tertiary eye care center in South India. Oman J Ophthalmol Sep-Dec. 2015;8(3):171\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0974-620x.169891\u003c/span\u003e\u003cspan address=\"10.4103/0974-620x.169891\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePathengay A, Karosekar S, Raju B, Sharma S, Das T. Microbiologic spectrum and susceptibility of isolates in scleral buckle infection in India. Am J Ophthalmol Oct. 2004;138(4):663\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2004.04.056\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2004.04.056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNuzzi G, Rossi S. Buckle removal in retinal detachment surgery: a consecutive case series. Acta Bio-medica: Atenei Parmensis. 2008;79(2):128\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeokule S, Reginald A, Callear A. Scleral explant removal: the last decade. Eye. 2003;17(6):697\u0026ndash;700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Rouic JF, Bettembourg O, D'Hermies F, Azan F, Renard G, Chauvaud D. Late swelling and removal of Miragel buckles: a comparison with silicone indentations. Retina Oct. 2003;23(5):641\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00006982-200310000-00006\u003c/span\u003e\u003cspan address=\"10.1097/00006982-200310000-00006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoisseiev E, Fogel M, Fabian ID, Barak A, Moisseiev J, Alhalel A. Outcomes of Scleral Buckle Removal: Experience from the Last Decade. Curr Eye Res May. 2017;42(5):766\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/02713683.2016.1245423\u003c/span\u003e\u003cspan address=\"10.1080/02713683.2016.1245423\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim KW, Park UC, Yu HG. Recurrence of Retinal Detachment after Scleral Buckle Removal. Korean J Ophthalmol Dec. 2020;34(6):454\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3341/kjo.2020.0099\u003c/span\u003e\u003cspan address=\"10.3341/kjo.2020.0099\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEshraghi H, Prenner JL, Zhang R, et al. Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes. Ophthalmic Surg Lasers Imaging Retina Mar. 2021;52(3):138\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/23258160-20210302-04\u003c/span\u003e\u003cspan address=\"10.3928/23258160-20210302-04\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt CW, Cohen HB. Exposed scleral buckle: a case report in an eleven-year course. Ophthalmic Surg Mar. 1983;14(3):238\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026eacute;bert M, Garneau J, Doukkali S, et al. Outcomes in Recurrent Rhegmatogenous Retinal Detachment Repair: Does Scleral Buckling at Primary or Secondary Surgery Impact Results? Clin Ophthalmol. 2025;19:949\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/opth.S507985\u003c/span\u003e\u003cspan address=\"10.2147/opth.S507985\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrigoyen C, Goikoetxea-Zubeldia A, Sanchez-Molina J, Amenabar Alonso A, Ruiz-Miguel M, Iglesias-Gaspar MT. Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain. J Clin Med Aug. 2022;4(15). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11154551\u003c/span\u003e\u003cspan address=\"10.3390/jcm11154551\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallaway NF, Vail D, Al-Moujahed A, et al. Sex differences in the repair of retinal detachments in the United States. Am J Ophthalmol. 2020;219:284\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerstenberger E, Stoffelns B, Nickels S, et al. Incidence of Retinal Detachment in Germany: Results from the Gutenberg Health Study. Ophthalmologica. 2021;244(2):133\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000513080\u003c/span\u003e\u003cspan address=\"10.1159/000513080\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindsey PS, Pierce LH, Welch RB. Removal of Scleral Buckling Elements: Causes and Complications. Arch Ophthalmol. 1983;101(4):570\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.1983.01040010570007\u003c/span\u003e\u003cspan address=\"10.1001/archopht.1983.01040010570007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhioua R, Ammous I, Errais K, et al. Frequency, characteristics, and risk factors of late recurrence of retinal detachment. Eur J Ophthalmol Nov-Dec. 2008;18(6):960\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/112067210801800617\u003c/span\u003e\u003cspan address=\"10.1177/112067210801800617\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwartz PL, Pruett RC. Factors Influencing Retinal Redetachment After Removal of Buckling Elements. Arch Ophthalmol. 1977;95(5):804\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.1977.04450050082007\u003c/span\u003e\u003cspan address=\"10.1001/archopht.1977.04450050082007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"scleral buckle removal, recurrent retinal detachment, infection, anatomic success, visual acuity","lastPublishedDoi":"10.21203/rs.3.rs-8694152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8694152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo 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.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e \u003cp\u003eRetrospective chart review\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA single-center analysis of patients operated for SBR was conducted at the Centre hospitalier universitaire de Qu\u0026eacute;bec \u0026ndash; Universit\u0026eacute; 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 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\u0026thinsp;=\u0026thinsp;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). Logistic regression analysis identified male sex as a significant risk factor for recurrent RD (OR\u0026thinsp;=\u0026thinsp;9.89, p\u0026thinsp;=\u0026thinsp;0.040).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInfection 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.\u003c/p\u003e","manuscriptTitle":"Removal of scleral buckle: indications, long-term outcomes and comparison with the literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 16:54:05","doi":"10.21203/rs.3.rs-8694152/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T08:56:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T19:17:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T16:13:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36561141948039354189539472968168405463","date":"2026-02-11T15:00:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110288606537859868961898518592353629568","date":"2026-02-10T18:20:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T16:28:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106561516292186177302087384417726280624","date":"2026-02-10T16:14:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-09T08:49:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T07:43:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T06:03:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Retina and Vitreous","date":"2026-01-25T17:49:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1edf0c91-bf52-4d0c-866b-f36433309dc8","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T08:38:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 16:54:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8694152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8694152","identity":"rs-8694152","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}