Surgery Overview
Scleral buckling surgery is a common
way to treat
retinal detachment. It is a method of closing breaks
and flattening the
retina. See a picture of a
detached 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. See a picture of a
scleral buckle in place.
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.
Sometimes your eye doctor may inject a
gas bubble into your eye to flatten the retina. He or she may also drain the
fluid under the detached retina through a tiny hole in the sclera. If there is
only a small amount of fluid, draining it may not be needed. The retina will
pump it out.
Other facts about the surgery
- The surgery usually takes place in a
hospital. Detachments can usually be repaired on an outpatient basis (you go
home the same day) in the hospital or in an outpatient surgical
center.
- 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.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. The
potential benefits of surgery usually far outweigh the risks.
- 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, the middle layer of tissue that
forms the eyeball, is a common complication of scleral buckling surgery.
Choroidal detachments usually develop 1 or 2 days after surgery and may
increase in size for 2 or 3 days. But they usually heal on their own within
about 2 weeks without further treatment.
- 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.
- You may have swelling or inflammation of
the macula (the central portion of the retina), other parts of the retina, or
the membranes surrounding the retina.
- 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.
- Many people need more than one operation. Surgery always
poses some risks.
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).
- Cataracts may form after surgery,
although they are less common with scleral buckling than with pneumatic
retinopexy or vitrectomy, the other types of surgery used to treat retinal
detachments.
What To Think About
Scleral buckling
usually requires use of a hospital operating room and may
require
general anesthesia. Doctors do some scleral
buckling procedures on an
outpatient basis, which may reduce the cost.
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
- American Academy of Ophthalmology Committee on
Ophthalmic Procedure Assessment (1996). The repair of rhegmatogenous retinal
detachments. Ophthalmology, 103(8):
1313–1324.
Credits
| By | Healthwise Staff |
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| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
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| Specialist Medical Reviewer | Carol L. Karp, MD - Ophthalmology |
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| Last Revised | August 7, 2011 |
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