Fig. 6.127 This inferior retinal U tear has lifted through the laser as the gas bubble has absorbed

5.The RRD subsides.

6.Leaving a flat retinal break on an apparently spontaneous choroidal effusion, laser the break and wait for the effusions to settle.

6.9.3Infection

An inflamed explant early in the postoperative period should be assumed to be infected and systemic oral antibiotics prescribed. Usually, this will settle the inflammation. Late onset infection is usually associated with erosion through the conjunctiva.

6.9.4Cosmesis

Plombage is often used in young patients with attached vitreous, and, therefore, the appearance of the eye is important. Patients should be warned that they may feel the explant under the lid and it may be visible on extreme eye movements but that it can be removed to improve the appearance.

6.9.5Irritation

If the end of the explant is high, an area of drying can occur in the conjunctiva.

6.9Removal of Explant

There are occasions when an explant will require removal approximately 1 in 25 explants:

6.9.1Diplopia

If the explant is placed beneath the extraocular muscles especially the vertical recti (there is a reduced fusion range vertically), diplopia can be induced. Remember that the indent is only required for as long as the retinopexy needs to take effect. Therefore, an explant can be removed at 2 weeks postop. If diplopia occurs, early removal of the plombage will usually resolve the situation. Sometimes diplopia is from unmasked prior phoria, for example, old forth nerve palsy.

6.9.2Erosion Through Conjunctiva

With time, the end of an explant can erode through the conjunctiva causing pain and discharge in the eye. If the erosion is large enough, the explant should be removed at the slit lamp. The wound will granulate and close spontaneously. The wound cannot be repaired over the explant, and it must be removed before orbital infection occurs.

6.9.6Surgery for Removal of the Explant

Inject some local anaesthetic over the end of the explant that is most accessible. Cut down through the conjunctiva and Tenon’s onto the end of the explant. The explant is covered very rapidly in the postoperative period by a thick fibrous capsule. Cut down onto the explant through this capsule and

Fig. 6.128 Make sure the incision in the tough capsule at the end of the plomb will be big enough to allow the plomb to come out, approximately 1.5 × the diameter of a cylindrical plomb