Scleral buckling surgery is one of the ways to treat retinal detachment. It is a method of closing breaks, bringing the two layers of the retina back together, and getting rid of fluid under the retina.
A scleral buckle is produced by a piece of silicone sponge, rubber, or semi-hard plastic that your eye doctor (ophthalmologist) places on the outer layer of the eye (the sclera, or the white of the eye). The material is sewn to the eye to keep it in place. The buckling element is usually left in place permanently.
The element pushes in, or “buckles,” the sclera toward the middle of the eye. This buckling effect on the sclera relieves the pull (traction) on the retina, allowing the retinal tear to settle against the wall of the eye. The buckle effect may cover only the area behind the detachment, or it may encircle the eyeball like a ring.
By itself, the buckle does not prevent a retinal break from opening again. Usually extreme cold (cryopexy) or less commonly, heat (diathermy) or light (laser photocoagulation) is used to scar the retina and hold it in place until a seal forms between the retina and the layer beneath it. The seal holds the layers of the eye together and keeps fluid from getting between them.
Sometimes your eye doctor may inject a gas bubble into your eye to close the break and prevent more fluid from passing through it during surgery. He or she may drain the fluid under the detached retina through a tiny hole in the sclera. If there is only a small amount of fluid, draining it may not be needed. The layer under the retina will absorb it.
Other facts about the surgery
The surgery takes place in a hospital. Detachments can usually be repaired on an outpatient basis (you go home the same day) in the hospital or in an outpatient surgical center.
Local or general anesthesia may be used.
A first-time surgery usually lasts 1 to 2 hours. Repeat surgeries or more complex detachments may take longer.
What To Expect After Surgery
You may have some pain for a few days after the surgery. Your eye may be swollen, red, or tender for several weeks. Your eye doctor may put drops in your eye that prevent infection and keep the pupil from opening wide (dilating) or closing (constricting). You may have to wear a patch over the eye for a day or more.
Why It Is Done
Scleral buckling is effective in repairing a tear, hole, or break in the retina that has caused the detachment. It is rarely helpful when scar tissue tugging on the retina has caused the detachment (traction detachment).
How Well It Works
Placing a scleral buckle reattaches the retina in most cases. The overall rate of reattachment success rises to above 90% with more than one procedure.
Chances for good vision after surgery are higher if the macula was still attached before surgery. If the detachment affected the macula, good vision after surgery is still possible but less likely.
Scleral buckling poses some short-term and long-term risks. Most of these complications do not happen very often. The potential benefits of surgery usually far outweigh the risks.
The most common cause of failure in surgery for retinal detachment is a type of scarring on the retina, called proliferative vitreoretinopathy (PVR), that can cause the retina to detach again. PVR usually requires additional treatment, including vitrectomy surgery.
Detachment of the choroid, the middle layer of tissue that forms the eyeball, is a common complication of scleral buckling surgery. Choroidal detachments usually develop 1 or 2 days after surgery and may increase in size for 2 or 3 days. However, they usually heal on their own within about 2 weeks without further treatment.
The pressure of the scleral buckle can raise the fluid pressure inside the eyeball. People with glaucoma may have a higher risk of this complication.
Bleeding in the eye can impair vision.
The eye may become infected. You may need antibiotics and corticosteroids to reduce redness or discharge from the eye and cure the infection.
You may have swelling or inflammation of the macula (the central portion of the retina), other parts of the retina, or the membranes surrounding the retina.
The plastic or rubber of the buckling device may rub on other parts of the eye, move out of place, or become a site of infection. In some cases, the buckling device may need to be removed.
Many people need more than one operation. Surgery always poses some risks.
The surgery may also affect your vision in other ways:
Since a scleral buckle pushes in on the eye, it can change the shape of the eye. Good vision depends on the shape of the eye. The change caused by a scleral buckle may cause a refractive error that can affect vision. Vision may change for several months after scleral buckling surgery. You should have a follow-up vision exam after about 6 months to check for vision changes. You may need glasses or contact lenses (or a new prescription) to correct the changes.
The scleral buckle can affect the eye muscles and how well they control the movement of the eyes. This can lead to misaligned eyes (strabismus) and double vision (diplopia).
Cataracts may form after surgery, although they are less common with scleral buckling than with pneumatic retinopexy or vitrectomy, the other types of surgery used to treat retinal detachments.
What To Think About
Scleral buckling is expensive, because it usually requires use of a hospital operating room and may require general anesthesia. It costs more than pneumatic retinopexy, an alternative treatment for certain types of detachments. A person with a retinal detachment often needs surgery more than once, so costs can add up. Doctors are performing some scleral buckling procedures on an outpatient basis, which may reduce the expense.