Intrusion of Dacron suture knot 15 years after scleral buckling
- 133 Downloads
We present a case of intrusion of a suture knot 15 years after scleral buckling surgery.
A 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15 years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o’clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached.
The suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.
KeywordsScleral erosion Dacron Scleral buckling surgery Secondary glaucoma
intra ocular pressure
‘Intrusion’ is the erosion and protrusion of a scleral suture or implant into the vitreous cavity . Pathological myopia, glaucoma, and scleral buckle tension are strong risk factors for intrusion . Silicone rubber, silicone buckles, silicone sponge, the Arruga suture, and polyethylene tubes have been reported to induce ocular intrusion [1, 3]. Many cases of encircling suture intrusion have been reported in the literature [4, 5]. However, there have been relatively few reports of the intrusion of the suture knot or anchoring suture [6, 7]. Here, we report a case of the intrusion of a Dacron suture knot 15 years after scleral buckling surgery.
Most reports of suture intrusion have concerned encircling sutures [4, 5], which are actually encircling bands. The intrusion of an anchoring suture or suture knot is relatively rare [6, 7]. Here, we have reported a case of the intrusion of a PET suture knot 15 years after scleral buckling surgery.
The manifestations of intrusion vary, from asymptomatic to severe visual loss attributable to vitreous haemorrhage or retinal detachment [1, 2, 8, 9, 10, 11]. In our case, the patient presented with highly elevated IOP and eye pain, headache, and nausea, and a clinical examination detected hyphema and vitreous haemorrhage. The intrusion of the suture knot was only found during surgery, so in patients with a history of scleral buckling, the possibility of intrusion must be considered.
An analysis showed that the suture was PET, possibly Dacron, a nonabsorbable suture from Alcon. PET is a compound synthesized from ethylene glycol and terephthalic acid in a polycondensation reaction, and is highly resistant to disintegration when buried in tissue [12, 13]. In our patient, the suture knot was resting on a ring-shaped protrusion, and both the knot and the encircling silicone band were intact. Therefore, it is unlikely that the node was the anchoring suture for the encircling silicone band, but rather that the suture had been used to close the drainage port for subretinal fluid, and was covered by the encircling band. Weinberger reported that the intrusion of anchoring sutures occurs as a late complication of retinal detachment surgery when the extra-scleral buckling technique is used . But in our case, the suture was not the anchoring one. Schepens reported that erosion commences and progresses as the implant is held firmly against the sclera by the sutures, the encircling element, or the solid scar tissue that has grown over the external surface of the implant .In our case, the Dacron knot may have been held against the scleral wall by the encircling band. The patient was highly myopic, another risk factor for intrusion. Moreover, the sclera was further weakened by the incision made for the drainage of the subretinal fluid. Cooper et al. reported a case in which a 5–0 Dacron scleral suture knot had eroded into the vitreous cavity 12 years after scleral laceration repair, pars plana vitrectomy, the removal of an intraocular foreign body, and a scleral buckling procedure for penetrating injury . In their case, the Dacron suture was used to close the scleral laceration, and had been covered with a 5 mm radial scleral sponge and overlain with an encircling 240 band. In both Cooper’s and our patients, the encircling band held the suture firmly against a sclera that had been compromised by a traumatic or surgical incision. Therefore, covering a nonabsorbable suture with an encircling band should be avoided in the buckling procedure, especially when the sclera is impaired by trauma, pathological myopia, or surgical incision. If a suture is unavoidable, then a soft, absorbable suture may be preferable.
In conclusion, when covered with an encircling band, a nonabsorbable suture, which is usually placed where the sclera has already been compromised, could erode the sclera and intrude into the vitreous cavity.
This work was supported by research grants from the National Natural Science Foundation of China (81570854) for designing the study and collecting data, the National Key Basic Research Program of China (2013CB967503) for analysis and interpretation data, and the Youth Project of the National Natural Science Fund 2018 (81800846) for writing the manuscript.
Availability of data and materials
All data generated and analyzed in this study are included within this manuscript.
RPG was a major contributor in acquisition of the data, literature search and manuscript draft. SF and GZX made contributions to conception and design, acquisition of data, and analysis and interpretation of data; XJC and GZX involved in drafting the manuscript and revising it critically for important intellectual content; CHJ did the surgery and participated in the revision of the manuscript. HHZ participated in the preparation and revision of the manuscript. All authors read and approved the final manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Consent for publication
Written informed consent was obtained from the patient for publication of this Case report. A copy of the written consent is available for review by the Editor of this journal.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
- 4.Dogan M, Agca A, Turna F, Altan T, Eltutar K. Intraocular intrusion of suture material that was used as scleral buckling material. Retin Cases Brief Rep. 2014;8(3):227–9.Google Scholar
- 5.Sánchez-Vicente JL, Rueda-Rueda T, González-García ML, López-Herrero F, Sánchez-Vicente P. Retinal detachment caused by Arruga suture scleral intrusion. Treatment. Arch Soc Esp Oftalmol. 2015;90(10):494–6.Google Scholar
- 7.Weinberger D, Lichter H, Gaton DD, Kremer I, Axer-Siegel R, Yassur Y. Intraocular intrusion of sutures after retinal detachment buckling surgery. Retina (Philadelphia, Pa). 1995;15(5):417–21.Google Scholar
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.