Retinal Detachment

[Sea Biscuit]

Nicoletann, I'm not giving any medical advice here, but I do have some questions for Lloyd about scleral buckles (I'm a cornea specialist). I agree with the others' advice to get a copy of the operative report from your retinal surgeon and ask specifically why diving is contraindicated.

Lloyd, I've read Butler's review in Survey of Ophthalmology (39:347,1995). Diving with a hollow orbital implant is an obvious no-no. No mention is made of porous sponges. The article states only that it's ok to dive 2 months after an RD repair, listing this procedure separately from laser, cryo, and procedures using gas. Since buckles are used in a significant percentage of RD repairs, the implication is that the buckles are not a problem. Assuming that you've used a sponge or other porous material as opposed to solid silicone, what would happen if one were to dive with it?

First, are the sponges closed- or open-cell material? Would any gas initially present in the sponge be replaced with fluid within a few weeks or months after surgery?

Second, assuming that gas is still present in the sopnge, what would happen to the eye as the sponge compresses? If it's just a radial sponge, wouldn't it simply reduce in volume without putting any additional pressure on the eye on the way down, and re-expand to its original volume upon surfacing? If it is an encircling band, will the inside diameter decrease, increasing external pressure on the eye? Or will the volume of the band decrease, making the buckle less effective at indenting the sclera?

Other than the issue of placing greater external pressure on the eye, would a sponge pose any other risks? I've had a number of patients with eroded buckles that had to be removed, and none of them re-detached. What is the risk of re-detachment when a buckle is removed? If it's not any higher than baseline, would there be any real risk associated with a temporary decrease in encircling band volume during a dive?

 

[Lloyd]

Sea Biscuit,
Sorry about the delay. I have not checked the board in awhile. You have some very good questions.
1. The sponges used to be open cell but had increased infection rate. Now they are closed cell silicon. So they are in fact a form of hollow implant since they have numerous closed cells.
2. You are correct the implant will reduce in volume and release pressure on the glob. If the band is sponge, it will also compress and relax pressure. The combination of a compressed band and compressed implant combine to decrease pressure on the scrlera.
3. There is about a 4% risk of detachment after buckle removel. So the repeat relaxation could possible induce another RD. Could the reapplication of pressure fix it? Probably. Could the band and implant shift while they are relaxed? Probably not if properly placed. As far as I know there is no data available. Ask around see what you come up with.
Lloyd

 

[BILLB]

I have both a buckle and an implant. The implant is in one eye and the other eye had cataract surgery 25 years ago. The surgery left a scare and eventually it was instrumental in detachment of the retina.

I have been diving for almost six years with this condition will no ill effects. If only my hearing would improve!

 

[Lloyd]

I have been rethinking my answers. Around here solid buckles are used. It is possible for a sponge band to decrease in length as the air cell collapse and cause the length to decrease, thus putting more pressure on the globe. If just a sponge band is used, this could decrease the IOP on surfacing secondary to increase pressure at depth and cause hypotony. I have talked to some other ophth. about this. We will ask the Prof. of retinal surgery when he returns from vacation.
Have to run.
Lloyd

 

[Sea Biscuit]

My wetsuit encircles me, yet doesn't squeeze me any more than the surrounding water as it compresses. Or is it that I just can't feel it? I'm guessing that a closed-cell silicone encirlcling band would similarly place no excess pressure on the eye as it compresses. I can't visualize how compression would result in a decreased inside diameter of the band. So no worries about increased intraocular pressure due to an encircling band at depth?

The other issue is the decrease in volume of the band or radial sponge at depth, resulting in decreased pressure on the sclera. Sponge volume, and pressure on the sclera, would be restored with resurfacing. The risks, which you've nicely stated, are those of sponge migration and/or retinal redetachment associated with repeated cycles of compression/decompression. I suspect that the only data available is anecdotal. I'm a little hesitant to make deductions from Butler's article, particularly if his experience may have been in the open-cell sponge era. We've got 2 people here on SB who have been diving without ill-effects after RD repair, but this is hardly a large sample size.

My guess is that there is some increased risk of re-detachment, but that it is probably very slightly above baseline. And that retinal surgeons are pretty good at anchoring sponges, so the risk of migration is very low as well.

Of course, my speculation could be totally off-base. None of the above is meant as medical advice for any specific individual, but is simply a theoretical analysis of a hypothetical situation.

Looking forward to seeing what the professor has to say.

 

[nicoletann]

I found out i have a silicon band around my eye. No other implants. Nothing to collapse i guess.

 

[El Buzo Loco]

I have a Bausch & Lomb C11UB in the right eye and Chiron Vision C11UB in the left eye...

Any contradictions known for diving with these implants? I've been to about 110-feet deep with them. Didn't realize that there might be an issue with implants.

The capsule had to be lasered out to about 6mm when it decided to go opaque on me.

I decided on monocular vision (one eye is set for distance and the other is set for close). Interestingly, I can see better under water than I can on land without my glasses.

 

[Sea Biscuit]

El Buzo - you've got intraocular lens implants (IOLs), which were inserted as part of cataract surgery. Different from the scleral implants/exoplants discussed above for retinal detachment surgery. IOLs contain no gas and pose no issues for diving. Neither does laser disruption of a cloudy posterior capsule.

 

[Lloyd]

SeaBisuit,
The retinal prof. thinks that sponges wouldn't shrink enough percentage wise to present a problem. It would be nice to have some real data. Maybe take one down while diving and see what happens.
Nicoletann, Solid band is safe by all sources.
Lloyd

 

[nicoletann]

i just completed my open water last weekend. so far so good!