Scleral buckling is a popular surgical procedure for the treatment of a retinal detachment. The surgeon closes the retinal break by attaching a buckle on the sclera to flatten the retina. A silicone sponge, plastic (semi-hard), or rubber can serve as the scleral buckle. The buckle is sewn in the eye permanently and is designed to push the sclera toward the break or tear. The buckle may not prevent a repeat retinal detachment, but it is effective in supporting the break, tear, or hole responsible for the detachment. For minor retinal detachments, a temporary buckle can be used and removed when the detachment has healed.
Retinal detachment refers to a spontaneous or trauma-related shift of the retina from its usual place. When it happens, it is an ocular emergency because it can lead to permanent vision loss. Incomplete detachments of the retinal can form tears. Retinal tears can be treated by scleral buckling before they develop into detachments. The most common form of retinal detachment is the rhegmatogenous form triggered by age and caused by retinal tears or holes.
There are several options for treating retinal detachments. One is the less invasive pneumatic retinopexy, which cannot handle all types of retinal tears or detachments, necessitating choices like scleral buckling. Vitrectomy is another procedure used to treat complicated cases of retinal detachments. Treatment options are made on a case-by-case basis.
Before the Procedure
An ophthalmic examination will be performed where the retina is examined. The eye may be dilated for the eye exam, and ultrasound is undertaken to view the detachment. The patient will have both eyes patched before the procedure and stay in bed so that the detachment does not spread. The patient's eyelashes will also be trimmed to keep them from interfering with the procedure.
The patient may be required to avoid certain medications before the surgery. S/he must avoid eating after midnight before the procedure. In most cases, surgery lasts one to two hours if it's done for the first time but may take longer for more complex detachments or repeat scleral buckling procedures. The surgery is performed in an outpatient setting.
The patient receives local or general anesthesia.
During the procedure, the surgeon:
- Administers dilating eye drops to enable the surgeon to see the back of the eye
- Makes an incision on the sclera to expose the eye
- Views the retina using an ophthalmoscope
- Uses a freezing instrument to seal the retina back to the inner wall of the eye. The surgeon can also use laser photocoagulation to burn the area around the tear or detachment
- Places a buckle around the outside of the eyeball. The buckle ensures the retina stays in place
- Drains some fluid from beneath the retina
- Applies an antibiotic ointment to prevent infection
- Patches the eye to protect it
Risks & Complications
Although scleral buckling is mostly successful, it carries risks and complications. The risks depend on a patient's age, medical condition, and extent of the detachment. The risks and complications may include:
- Blurry vision
- Cataract formation
- Retinal incarceration
- Repeated retinal tears
- Increased near-sightedness
- Repeated retinal detachments
- Bleeding in the eye which can impair vision
- Choroidal detachment which may delay healing
- The retina may reattach, but vision is not restored
- The layer of the eye beneath the retina can also detach
- The buckle may shift location or rub on other parts of the eye and may need to be removed
- Increased intraocular pressure especially in glaucoma patients due to the pressure brought about by a scleral buckle
- Infection which is treated with antibiotics. However, the buckle may sometimes need to be removed to treat an infection
- Proliferative vitreoretinopathy (type of scarring on the retina that can cause another retinal detachment) which may require an additional procedure, a vitrectomy
- The scleral buckle can cause strabismus (misaligned eyes) and diplopia (double vision) if it affects the extraocular muscles which are responsible for eye movement
- The buckle may alter the eye’s shape, yet good vision depends on its shape. These alterations in shape may lead to a refractive error and affect vision, requiring further addressing with glasses or contact lenses
The patient should immediately consult the doctor if they experience new flashes, floaters, or changes in vision. Other reasons to consult a doctor include discharge from the eye, decreasing vision, swelling, increased redness, and increased pain.
Aftercare & Recovery
The patient wears a patch on the eye for a few days after the procedure. Redness, eye tenderness, and inflammation can last for a few weeks after surgery. The patient takes antibiotics to prevent infection, while anti-inflammatory medications can deal with the swelling. S/he can expect some pain on the day of the procedure, or for several days. Anti-medication pains will be prescribed to relieve the pain. Some eye drops are also used to stop the eyes from dilating or constricting.
Swelling on the eye can also be relieved by placing a cold or ice pack over the eye for 10 to 20 minutes. The ice pack is wrapped around a towel and placed on the skin. The patient can use the ice pack every 1-2 hours during the first three days after the procedure.
The patient should avoid engaging in strenuous activities such as heavy lifting, exercise, and cleaning. Even reading should be limited to avoid straining the eyes. The patient can go back to work after two weeks following surgery. S/he should also wear protective sunglasses.
Close follow up is necessary after a scleral buckling procedure. The first follow-up visit is scheduled for the day after surgery. Subsequent visits will depend on the specific healing process of the patient. Because vision may change for several months following the procedure, the doctor may schedule an appointment after six months to check if changes in vision have occurred.
Scleral buckling reattaches the retina in most patients with higher chances for patients to obtain good vision if the macula was still attached before the procedure. If the macula was affected, good vision is still possible after surgery. Also, periphery detachment heals faster than one located in the macula.
According to the National Institute of Health, the success rate for scleral buckling is 85–90%. For vision to be restored, factors like location, the detachment's extent, and the time it took to repair the detachment are determinants. The detachment must be attended to immediately for better visual outcomes.