Surgery Overview

Scleral buckling surgery is a common
way to treat
retinal detachment. It is a method of closing breaks
and flattening the
retina.

A scleral buckle is a piece of silicone sponge,
rubber, or semi-hard plastic that your eye doctor (ophthalmologist) places on the outside 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.

Other facts about the surgery

  • The surgery takes place in an operating room, usually on an outpatient basis (you go
    home the same day).
  • Local or general anesthesia may be
    used.
  • Before the surgery, your eye doctor may patch both of your
    eyes and have you stay in bed to keep the detachment from spreading. Right
    before surgery, he or she will use eyedrops to dilate your pupils and may trim
    your eyelashes to keep them out of the way.
  • 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.

Contact your doctor right away if you notice any signs of
complications after surgery, such as:

  • Decreasing vision.
  • Increasing
    pain.
  • Increasing redness.
  • Swelling around the
    eye.
  • Any discharge from the eye.
  • Any new
    floaters,
    flashes of light, or changes in your field of
    vision.

Why It Is Done

Scleral buckling is effective in
supporting a tear, hole, or break in the retina that has caused the detachment.
It is rarely helpful on its own 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.footnote 1

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.

Risks

Scleral buckling poses some short-term and
long-term risks. Most of these complications do not happen very often. Risks include the following:

  • 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 (a part of the tissue that
    forms the eyeball) or swelling in the retinal area may delay healing.
  • 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 treat the
    infection. Sometimes it is necessary to remove the buckling implant
    to treat the infection.
  • 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.

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).

What To Think About

There are a few
ways to repair a retinal detachment. The chance that each surgery type can help
restore good vision varies from case to case. The cause, location, and type of
detachment usually determine which surgery will work best. Other conditions or
eye problems may also play a role in the decision.

You may
need more than one surgery to reattach the retina if scar tissue from the first surgery grows over the surface of your retina.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Committee on Ophthalmic Procedure Assessment, American Academy of Ophthalmology (1996, reaffirmed 2012). The repair of rhegmatogenous retinal detachments. Ophthalmology, 103(8): 1313-1324.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Carol L. Karp, MD – Ophthalmology

Current as ofMarch 3, 2017

Committee on Ophthalmic Procedure Assessment, American Academy of Ophthalmology (1996, reaffirmed 2012). The repair of rhegmatogenous retinal detachments. Ophthalmology, 103(8): 1313-1324.