the migration of an encircling silicone band through a rectus muscle is a rare postoperative complication associated with the scleral buckling procedure .
however , both kreis et al .   and tan et al .   have reported cases of this rare complication . here , we describe what we believe to be the first reported case of a scleral buckling - associated encircling silicone band that migrated through the rectus muscles , despite the band being securely surgically fixed to the sclera in the scleral tunnel ; i.e. , a review of the video recording of the surgery confirmed that the encircling band had been placed under the medial rectus muscles during the scleral buckling surgery .
a 58-year - old man presented with a rhegmatogenous retinal detachment in his left eye .
pars plana vitrectomy with the placement of an encircling silicone band ( # 240 ; mira , inc . , waltham , ma . , usa )
the solid silicone band was placed under the four rectus muscles and surgically fixed in a scleral tunnel at all four quadrants ( fig 1 ) .
the scleral tunnels were prepared by making two vertical incisions of one - half of the scleral thickness , and then performing a lamellar dissection with a surgical blade .
the anterior extent of each tunnel was 2.02.5 mm posterior to the rectus muscle insertions .
one year later , the patient complained of a mild foreign body sensation in his left eye . upon examination ,
the encircling band was found to be exposed on the nasal side of conjunctiva next to the limbus ( fig 2 ) .
the patient did not report any diplopia , and the movement of the associated eye in the field of the medial rectus muscle was found to be normal .
two weeks later , the encircling silicone band was surgically removed without any complications . during that surgery
, it was noted that the encircling band had cheese - wired through the medial rectus muscle , which had become reattached close to its original insertion with no thinning . at the patient 's most recent follow - up ,
although it has been reported that a solid silicone band can cheese - wire forward through the rectus muscle postoperatively [ 3 , 4 ] , the underlying mechanism of that migration has yet to be elucidated .
it has been suggested that a migration of an encircling band may occur if the band is embedded too deeply , placed anterior to the equator , and not securely anchored to the sclera . in the case shown in this present study , the encircling band was fixed in the scleral tunnel at all four quadrants .
a previous study has shown that as with the use of sutures , the use of a scleral tunnel is an alternative and secure method of anchoring an encircling band . however , in the case shown in this present study , we theorize that the band migration possibly resulted from the scleral flaps being thin .
an alternative explanation as to why the band migrated is that it might have been placed over the rectus muscle .
however , a review of the video recording of the surgery confirmed that the encircling band had actually been placed beneath the muscle .
it has been reported that migrating bands can induce ocular motility disturbances [ 3 , 4 ] .
tan et al .   reported a case with ocular motility disturbances in whom reattachment of the cheese - wired lateral rectus muscle was not observed . in the case shown in this present study ,
the cheese - wired medial rectus muscle was found to have become reattached close to its original attachment site .
we theorize that this was the reason why the ocular motility in our patient was preserved .
reportedly , the slow process of cheese - wiring migration through rectus muscle allows sufficient time for the muscle to reattach spontaneously behind the migrating band . in conclusion ,
the findings of this study show that migration of an encircling element can occur within 1-year after placement , and with subtle symptoms such as foreign body sensation . to prevent cheese - wiring migration , a scleral tunnel that is both deep and long enough to securely fix the silicone band
even when an encircling silicone band is surgically secured around the eye , periodic and detailed postoperative follow - up examinations and careful surgical procedures should be performed to ensure no migration of the band .
 the migration of an encircling silicone band through a rectus muscle is a rare postoperative complication associated with scleral buckling surgery for retinal detachment . in this present study 
 , we describe what we believe to be the first reported case of a patient who experienced postoperative migration of an encircling silicone band through the rectus muscle , despite the band being surgically secured to the sclera in a scleral tunnel . a 58-year - old man presented with a rhegmatogenous retinal detachment in his left eye . 
 pars plana vitrectomy was performed with the placement of an encircling silicone band , and the patient 's retina was successfully reattached . 
 one year postoperatively , the encircling band became exposed on the nasal side of the conjunctiva next to the limbus without any symptoms . 
 two weeks later , the exposed encircling band was surgically removed without any complications . 
 the findings of this study show that even when an encircling silicone band is surgically secured around the eye , periodic and careful postoperative follow - up examinations should be performed to ensure no migration of the band . 
Introduction
Case Report
Discussion
Statement of Ethics
Disclosure Statement