Definition & Overview

Scleral buckling is one of the traditional treatment methods for retinal detachment, a serious condition that occurs when the retina separates from the surrounding tissue that supports it. The procedure involves sewing a piece of silicone rubber or sponge-like material, called a scleral buckle, on the sclera (white part of the eye) so the retina will settle against the eye wall.

Who Should Undergo and Expected Results

Scleral buckling is one of the treatment options for patients suffering from retinal detachment, a serious eye disorder in which the retina peels away from the layer of tissue that supports it. It is a slowly progressing disorder, with most cases starting with localised detachment and progressing until the entire retina detaches completely, placing the patient at risk of total vision loss. Thus, scleral buckling is considered as an emergency surgical procedure performed to help prevent blindness.

Symptoms of retinal detachment include:

  • Photopsia, or when the patient sees flashes of light
  • Floaters, usually in the temporal side of the central vision
  • Dense shadow affecting the peripheral vision and moving gradually towards the central vision
  • Veiled or curtained vision
  • Central vision loss
    Retinal detachment commonly affects patients who also suffer from other ophthalmic conditions, such as cataracts and severe myopia. It can also be caused by genetics and trauma to the eye, and can thus also present in various degrees of severity.

Retinal detachment has different types, namely:

  • Rhegmatogenous retinal detachment, which is caused by a tear in the retina
  • Exudative or secondary retinal detachment, in which the retina becomes inflamed and detaches due to injury or vascular problems
  • Tractional retinal detachment, in which fibrovascular tissue applies traction on the retina, causing it to detach
    A scleral buckling can be performed at any stage of retinal detachment and is generally effective in reattaching the retina, giving the patient a good chance of regaining good vision. However, the procedure has its limitations and is not known to prevent retinal detachment or protect against recurrences. It is also not helpful in cases of traction detachment, a condition wherein the detachment is caused by scar tissue that tugs on the retina, and in cases wherein the macula has also become detached. Due to these limitations, scleral buckling is not as popular as other treatment options used for retinal detachment such as cryopexy and laser photocoagulation.

How is the Procedure Performed?

A scleral buckling is performed in an operating room but does not require an overnight stay in the hospital. Anaesthesia, either local or general administered in the form of eye drops or injections, is also necessary to ensure patient’s comfort during the procedure. While waiting for the procedure, the patient’s affected eye is usually patched to prevent the detachment from progressing.

On the day of the procedure, the patient is given dilating eye drops and the surgeon proceeds by sewing fine bands of silicone plastic or sponge onto the sclera where retinal tear or detachment is located. This effectively pushes the sclera toward the tear and causes the retina to reattach. This results in scarring that seals the tear in the retina.

The procedure typically takes one to two hours, but it may take longer in the case of repeat surgeries and complicated detachments.

Possible Risks and Complications

Scleral buckling is associated with a number of short and long-term risks and possible complications, although they rarely occur. These include:

  • Infection – The eyes are vulnerable to infection during the healing process. In order to keep this risk under control, patients are prescribed with antibiotic eye drops, which also help keep the pupil from dilating and constricting.

  • Proliferative vitreoretinopathy (PVR) – This is a condition wherein scarring forms on the retina, which can cause the retina to become detached again.

  • Choroid detachment – This occurs when the choroid, a tissue that forms part of the eyeball, also becomes detached, delaying the healing process.

  • Increased fluid pressure inside the eyeball – This complication most commonly affects patients who also suffer from glaucoma.

  • Refractive error and vision changes – A scleral buckle can change the shape of the eye, which can result in refractive errors and vision problems.

  • Strabismus - A scleral buckle can affect the muscles of the eyes. If eye movement is affected, it can cause misaligned eyes.

  • Diplopia – The presence of a scleral buckle in the eye may also cause double vision.

Symptoms that indicate a possible complication include:

  • Increased pain
  • Redness and swelling that increase rather than subside
  • Abnormal eye discharge
  • Floaters
  • Any changes in vision
  • Decreasing vision
    As a preemptive measure, ophthalmologists conduct regular follow-up consultations scheduled on the 1st, 4th, 8th, and 12th weeks after the procedure. This is followed by annual examinations to watch for signs of recurrence.

    References:

  • Schwartz S., Kuhl D., McPherson A. et al. (2002). “Twenty-Year Follow-up for Scleral Buckling.” Arch. Ophthalmol. 2002;120(3):325-329. http://archopht.jamanetwork.com/article.aspx?articleid=269749

  • Salicone A., Smiddy W., et al. (2006). “Visual Recovery after Scleral Buckling Procedure for Retinal Detachment.” Department of Ophthalmology, Bascom Palmer Eye Institute. http://www.aaojournal.org/article/s0161-6420(06)00693-2/abstract

  • Dehghani A., Razmjoo H., Fazel F., et al. (2013). “The comparison of retinal blood flow after scleral buckling with or without encircling procedure.” J Res Med Sci. 2013 Mar;18(3):222-224. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732903/

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