Delayed Scleral Buckle Removal in Cases of Exposure, Extrusion, and Infection: Clinical Features, Microbiologic Aspects, and Clinical Outcomes

Purpose: To report the clinical features, microbiologic aspects, and clinical outcomes of delayed scleral buckle removal. Methods: This retrospective study included all eyes undergoing delayed scleral buckle removal at Bascom Palmer Eye Institute between 2013 and 2024. Delayed removal was defined as removal more than 1 month after placement. Only eyes with exposure, extrusion, or infection were included. Cases of scleral buckle removal for reasons such as ocular pain or strabismus were excluded. Clinical examination findings, operative reports, and microbiologic culture results were reviewed. Results: The current study included 50 eyes of 50 patients. The median time from scleral buckle placement to removal was 134 months (range, 1-564). Common presenting symptoms included eye pain, foreign body sensation, discharge, redness, and blurry vision. Six eyes were asymptomatic at presentation. Conjunctival erosion was present in 49 eyes, most frequently located in the superonasal (35%) and superotemporal (35%) quadrants. The most commonly explanted element was an encircling band (81%), with sponges removed in 14% of cases. Microbiologic cultures were positive in 40% of eyes, most commonly yielding Staphylococcus aureus (5 cases), Pseudomonas aeruginosa (4 cases), and S. epidermidis (3 cases). Recurrent retinal detachment occurred in 4 eyes (8.3%), with a mean time to redetachment of 81.5 days. Conclusions: Scleral buckle removal was associated with a positive microbial culture rate of 40%. After buckle removal, the incidence of recurrent retinal detachment was low.