The scleral buckle is usually permanent.

The scleral buckle is usually permanent.

The scleral buckle is usually permanent. However, in the case of minor retinal detachment, a temporary buckle may be used, which is removed once the eye heals.

What is scleral buckling?

Scleral buckling is a surgical procedure performed to treat retinal detachment or retinal tears. The retina is a layer inside the eye that transmits visual information to the brain. Due to some disease or trauma, the retina may separate from the structures that provide it with blood supply. This is called retinal detachment. Retinal detachment is a medical emergency because it can cause irreversible vision loss if left untreated. The sclera is the white outer part of the eye and supports the eyeball. In this procedure, the surgeon attaches a piece of silicone or a sponge from the sclera to the site of retinal detachment or retinal tear. The scleral buckle works by pushing the sclera toward the retinal tear or detachment, thus repairing it. Scleral buckling may be combined with other procedures that are used to treat retinal tears and detachments like laser photocoagulation and cryopexy.

What are the signs and symptoms of retinal detachment?

The signs and symptoms of retinal detachment include:

  • A sudden increase in the number of eye floaters
  • Small specks are seen in the field of vision
  • Flashes of light in the field of vision
  • Reduced or loss of peripheral vision

How is scleral buckling performed?

Before surgery:

Patients are advised not to eat or drink anything for at least 6 hours before the surgery. The surgeon may also advise the patient to temporarily discontinue certain medications, such as anticoagulants, as they increase the risk of bleeding during and after surgery.

During surgery:

  • Scleral buckling takes place in a surgical setting, in the operation room. The surgery is performed under general anesthesia or IV sedation along with local anesthesia administered to the eye. The surgery takes around 45 to 60 minutes.
  • The pupils are dilated (made bigger) with eye drops.
  • A cut is made over the outer layer of the eye, the sclera.
  • The scleral buckle is then surgically stitched (sutured) and fixed around the sclera. The buckle supports the retina and pushes the sclera toward the middle of the eye, pushing the retina, reattaching the detached retina, and closing retina tears.
  • To prevent a further tear or detachment of the retina, the surgeon may perform other procedures that are used to treat retinal tears and detachments like laser photocoagulation and cryopexy to reinforce the results of scleral buckling:

Laser photocoagulation: A laser beam is used to create thermal energy to burn tissue, which creates scar tissue, helping seal a tear or stop fluid leakage.

Cryopexy: Extreme low temperature is used to freeze the outer surface of the eye, which causes scar tissue formation and seals tears and leaks.

  • Any excess fluid accumulated behind the retina is drained.
  • Antibiotic eye drops are applied to prevent infection.

After surgery:

  • Antibiotics and painkillers are administered
  • The patient can go home the same day after surgery once the anesthesia wears off
  • An eye patch may need to be worn for a few days
  • Ice packs may be used to reduce pain and swelling
  • Antibiotic eye drops may be prescribed for 6 weeks
  • Pain, redness, and swelling resolves in 1-2 weeks
  • Protective eyewear should be worn while showering to prevent soap or shampoo entering the eyes
  • Sunglasses need to be worn during the day
  • Excessive screen time, exercise, sports, swimming, driving, and resuming work should be avoided for a few weeks until the doctor approves
  • Air travel and high-altitude treks should be avoided until the eye heals because high altitudes can increase eye pressure
  • Recovery time is anywhere from 2-8 weeks.

What are the complications of scleral buckling?

The surgery provides good outcomes; however, there are risks associated with the surgery, which include:

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Medically Reviewed on 9/30/2020
References
https://eyewiki.aao.org/Scleral_buckling_for_rhegmatogenous_retinal_detachment

https://emedicine.medscape.com/article/1844313-overview

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