Scleral Buckle

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Scleral Buckle

Scleral buckle surgery is a common procedure for repairing a retinal detachment. Retinal detachment often occurs when the vitreous, the gel-like substance that fills the eye, adheres to the retina and pulls it out of place. This can lead to retinal breaks, allowing liquid vitreous to flow through and underneath the retina, separating it from the eye wall. Retinal detachment is considered a medical emergency and requires immediate treatment. The scleral buckle procedure can help repair a detached retina and prevent permanent vision loss.

Types of Retinal Detachment

There are three main types of retinal detachment:

• Rhegmatogenous: The most common type of retinal detachment, rhegmatogenous detachment occurs when a tear or break in the retina allows fluid to accumulate beneath it.
• Tractional: This type of detachment occurs when scar tissue on the surface of the retina contracts and pulls the retina away.
• Exudative: This detachment is caused by fluid leaking from blood vessels behind the retina, but it doesn’t involve any tears or breaks in the retina.

Retinal Detachment Symptoms

Common symptoms of retinal detachment include:

• A sudden increase in floaters
• The sudden appearance of flashes of light
• A shadow or curtain on the side of your vision
• Sudden vision loss

What to Expect During a Scleral Buckle Procedure

A scleral buckle procedure is typically performed in an operating room. Before the surgery, you may receive anesthesia to help you relax and possibly to make you sleep. In some cases, you might remain awake during the procedure, but your eye care provider will administer medication to ensure you don't experience any pain.

To begin, your eye care provider will dilate your eye using eye drops. They'll make an incision in the outer layer of your eye and use a special tool to view your retina. Next, they'll use a freezing device to seal your retina back together.

Finally, your surgeon will place a silicone band (buckle) around the outside of your eye like a belt to keep the retina in place. They'll apply an antibiotic to prevent infection and give you a patch to cover your eye while it heals. A first-time scleral surgery typically takes 1-2 hours.

Scleral Buckle Risks and Complications

Scleral buckle surgery, like any surgical procedure, carries certain risks. However, these complications are rare, and your retina surgeon will take all possible measures to minimize them. Potential complications include:

• Failure to reattach the retina
• Bleeding
• Infection
• Eye inflammation
• Cataract formation
• Increased eye pressure

In some cases, additional procedures such as laser surgery or eye injections may be required. If you experience worsening pain or inflammation, a decrease in vision, or notice new flashes and floaters in your field of vision, it's important to contact your retina specialist as soon as possible.

Scleral Buckle Recovery

After the procedure, your retina specialist will give you instructions on how to position your head for proper healing. They will also recommend over-the-counter medications to relieve any discomfort you might experience for a few days after surgery. It's crucial to attend all follow-up appointments. Visual improvement after surgery can take several months and typically requires a new eyeglass or contact lens prescription.

Long-Term Effectiveness of Scleral Buckle

The long-term effectiveness of a scleral buckle is generally high. However, ​​even after successful surgery, there’s a small risk of the retina becoming detached again, which may require further surgery. Scleral buckle patients should schedule regular follow-up appointments with their eye care provider. These check-ups are crucial for monitoring the retina and addressing any potential complications early. Additionally, patients should be aware of symptoms that may indicate problems, such as a sudden increase in floaters, flashes of light, or a shadow in their vision.

Additional and Alternative Procedures

The main alternatives to scleral buckle surgery for retinal detachment are vitrectomy and pneumatic retinopexy. Vitrectomy involves removing the vitreous gel to relieve tension on the retina, often used for complex detachments, while pneumatic retinopexy is a less invasive procedure that uses a gas bubble and cryotherapy or laser to repair simpler detachments. A combination of methods is sometimes used depending on the complexity of the retinal detachment.