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Scleral Buckling Surgery for Retinal Detachment

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 theoutside 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 elementis usually left in place permanently.

The element pushes in, or "buckles," the sclera toward the middle of the eye. This bucklingeffect on the sclera relieves the pull (traction) on the retina, allowing the retinal tear to settleagainst the wall of the eye. The buckle effect may cover only the area behind thedetachment, or it may encircle the eyeball like a ring. See a picture of a scleral buckle inplace .

By itself, the buckle does not prevent a retinal break from opening again. Usually extremecold (cryopexy) or, less commonly, heat (diathermy) or light (laser photocoagulation) is usedto scar the retina and hold it in place until a seal forms between the retina and the layerbeneath it. The seal holds the layers of the eye together and keeps fluid from gettingbetween them.

Sometimes your eye doctor may inject a gas bubble into your eye to flatten the retina. He orshe may also drain the fluid under the detached retina through a tiny hole in the sclera. Ifthere is only a small amount of fluid, draining it may not be needed. The retina will pump itout.

Other facts about the surgery

The surgery usually takes place in a hospital. Detachments can usually be repaired on anoutpatient basis (you go home the same day) in the hospital or in an outpatient surgicalcenter.

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 fromspreading. Right before surgery, he or she will use eyedrops to dilate your pupils and may trim your eyelashes to keep themout 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 eyedoctor 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.

Symptoms | Doctors | Health Care Reform

Article Link: http://www.webmd.com/eye-health/scleral-buckling-surgery-for-retinal-detachment

1/8/14 Scleral buckling surgery for retinal detachment

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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 onits 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 themacula, 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 potentialbenefits 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 proliferativevitreoretinopathy (PVR), that can cause the retina to detach again. PVR usually requires additional treatment, includingvitrectomy surgery.

Detachment of the choroid, the middle layer of tissue that forms the eyeball, is a common complication of scleral bucklingsurgery. Choroidal detachments usually develop 1 or 2 days after surgery and may increase in size for 2 or 3 days. But theyusually 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 riskof 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 andtreat 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 themembranes 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 theeye. The change caused by a scleral buckle may cause a refractive error that can affect vision. Vision may change for severalmonths after scleral buckling surgery. You should have a follow-up vision exam after about 6 months to check for visionchanges. 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 tomisaligned eyes (strabismus) and double vision (diplopia).

Cataracts may form after surgery, although they are less common with scleral buckling than with pneumatic retinopexy orvitrectomy, 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 scleralbuckling 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 fromcase to case. The cause, location, and type of detachment usually determine which surgery will work best. Other conditions oreye 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 yourretina.

Complete the surgery information form (PDF) to help you prepare for this surgery.

Citations

1/8/14 Scleral buckling surgery for retinal detachment

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WebMD Medical Reference from Healthwise

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

By Healthwise Staff

Primary Medical Reviewer Adam Husney, MD - Family Medicine

Specialist Medical Reviewer Carol L. Karp, MD - Ophthalmology

Last Revised August 7, 2011

Last Updated: August 07, 2011

This information is not intended to replace the advice of a doctor. Healthwise disclaims any

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