Transmuscular migration of solid silicone band

Sir, The article ‘Transmuscular migration of 240 silicone encircling band’ by Kreis _et al_1 has prompted us to share our experience with a similar case. We recently reviewed a 71-year-old

man who presented with an 8-week history of horizontal binocular diplopia after bumping his head against a lamppost. Past ocular history included left retinal detachment surgery in 1999 with

MIRA 276 and 240 silicone bands without post-operative diplopia at discharge. Visual acuities were 6/6 OD, 6/36 OS. There was limitation of abduction in the left eye and a left esotropia

worse for distance than for near, mimicking sixth nerve palsy. Slit lamp examination revealed several eyelashes embedded beneath the conjunctiva, drawing attention to an area of conjunctival

erosion superotemporally (Figure 1), where the silicone band and anchoring suture were found to be exposed (Figure 2). During surgery for removal of the silicone band, the lateral rectus

was not recognized at its insertion. Although repositioning of the muscle was not attempted, his diplopia improved postoperatively and was successfully treated with prisms. This suggested a

possible element of mechanical restriction contributing to the diplopia, as a bulky explant beneath the tendon of the medial rectus can effectively shorten the muscle, limiting its ability

to stretch.2 Diplopia with ocular motility disturbances as a result of migrating buckling elements through the recti muscles has been well documented,3, 4, 5 including those requiring

surgical repositioning of the transected tendon.3 Ocular motility disturbances did not occur as one might expect in several cases4, 5 that were thought to be unique, in that reattachment of

the muscle fibres or sheath relatively closely behind the migrating element possibly allowed preservation of recti function.4 Lanigan,5 in a series of five patients, reported two with ocular

motility disturbances and cautioned that a larger series is needed before one can comment on the true incidence of ocular motility dysfunction following this complication. Therefore, it may

be misleading to conclude that ‘the migrating encircling band is not usually linked to ocular motility disturbance’. We suggest that it is important to consider migration of encircling

elements in the differential diagnosis of diplopia in patients with previous scleral buckling procedures to ensure that important clinical signs are not overlooked in examination. REFERENCES

* Kreis AJ, Klainguti G, Bovey EH, Wolfensberger TJ . Transmuscular migration of 240 silicone encircling band. _Eye_ 2006; 20: 1456–1458. Article  CAS  Google Scholar  * Seaber JH, Buckley

EG . Strabismus after retinal detachment surgery: etiology, diagnosis, and treatment. _Semin Ophthalmol_ 1995; 10: 61–73. Article  CAS  Google Scholar  * Macleod JDA, Morris RJ . Detached

superior rectus following scleral buckling: anatomy and surgical management. _Eye_ 1997; 11: 30–32. Article  Google Scholar  * Maguire AM, Zarbin MA, Elliott D . Migration of solid silicone

encircling element through four rectus muscles. _Ophthalmic Surg_ 1993; 24: 604–607. CAS  Google Scholar  * Lanigan LP, Wilson-Holt N, Gregor ZJ . Migrating scleral explants. _Eye_ 1992; 6:

317–321. Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Manchester Royal Eye Hospital, Central Manchester, UK L T Tan * West Wales General

Hospital, Carmarthen, UK N Thackare, G Zohdy & John Roberts-Harry Authors * L T Tan View author publications You can also search for this author inPubMed Google Scholar * N Thackare View

author publications You can also search for this author inPubMed Google Scholar * G Zohdy View author publications You can also search for this author inPubMed Google Scholar * John

Roberts-Harry View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to L T Tan. RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Tan, L., Thackare, N., Zohdy, G. _et al._ Transmuscular migration of solid silicone band. _Eye_ 21, 1013–1014 (2007).

https://doi.org/10.1038/sj.eye.6702824 Download citation * Published: 13 April 2007 * Issue Date: 01 July 2007 * DOI: https://doi.org/10.1038/sj.eye.6702824 SHARE THIS ARTICLE Anyone you

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