Scleral Buckle Surgery for Detached Retina

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What is Scleral Buckle Surgery?

Scleral buckle surgery, otherwise known as scleral buckling, is used to repair a retinal detachment.4 The sclera is known as the white of the eye. It is the outer supporting layer of the eyeball.

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During this procedure, a surgeon fixes a piece of silicone (or a sponge) onto the white of the eye around the retinal tear. The buckle helps repair retinal detachment by pushing the sclera toward the retinal break or tear.

The retina is a layer of tissue located on the inside of the eye. It sends visual information from the optic nerve to your brain. A detached retina moves from its usual position.

If left untreated, retinal detachment can lead to permanent vision loss. In some cases, the retina does not completely detach from the eye but instead creates a tear.

Scleral buckle surgery can sometimes help repair retinal tears, which can prevent retinal detachment.

When is Scleral Buckling Necessary?

Scleral buckle treatment is used for different types of retinal detachments. Retinal detachment is a medical emergency that requires immediate medical attention and care. Scleral buckling surgery is one of the treatment options.

Symptoms and side effects of detachment include a rise in the number of eye floaters. These are small, tiny specks that appear in your vision field. You may also see flashes of light in your vision field and reduced peripheral vision.

Who Performs Scleral Buckling?

Scleral buckling occurs in a surgical setting. An eye doctor or surgeon performs it.

How to Prepare for Scleral Buckling

Before scleral buckling, you’ll need to arrange for someone to pick you up after the surgery. Your doctor will inform you of any medications/foods you need to stop taking beforehand. 

You’ll also have the option to use general anesthesia, which helps you sleep during the surgery. In some cases, surgeons allow patients to remain awake. 

How Does Scleral Buckling Work (Procedure Steps)?

Here are the procedure steps you can expect during surgery: 5

  1. You may receive anesthesia before the surgery to fall asleep. If you are awake during surgery, your doctor or surgeon will apply eye drops or provide you with an injection to numb your eye. You will also receive eye drops to dilate your eyes. Dilation expands your pupil, enabling your doctor to see the back of your eye.
  2. Your eye doctor or surgeon will perform an incision on the outer layer of your eye (sclera).
  3. To stop a detachment or tear from reopening, your doctor may also perform another procedure. One of these is laser photocoagulation. During this procedure, your surgeon uses a laser beam to burn the area surrounding the retinal detachment or tear. This produces scar tissue, which seals a break and prevents fluid leakage. Or, your doctor may perform cryopexy. During this procedure, your doctor or surgeon uses extreme cold to freeze the outer surface of the eye. This can cause scar tissue to develop and seal a break.
  4. A buckle or sponge is stitched around the sclera. Then it is surgically sewn into place to prevent movement. Buckling helps support the retina by pushing the scleral toward the middle of the eye. This process can reattach your retina and close retinal tears.
  5. Following surgery, your doctor drains any fluid behind your retina and uses antibiotic eye drops to prevent infection.
  6. Scleral buckling is typically permanent. However, if you have minor retinal detachment, your doctor may use a temporary buckle. This buckle can be removed once the eye heals.

How Long Does Scleral Buckle Surgery Last?

Scleral buckle surgery takes approximately 45 minutes to complete.

Scleral Buckle Side Effects

Scleral buckle surgery may affect your vision in other ways.

As a scleral buckle pushes in on the eye, it can adjust the shape of the eye. Good vision following scleral buckle surgery depends on the shape of the eye. The adjustment caused by a scleral buckle may lead to a refractive error that can affect eyesight.

Vision may also change for several months following scleral buckle surgery. You should have a follow-up eye exam after about six months to check for vision changes. You may need glasses or contact lenses (or a new prescription) to fix the changes.

The scleral buckle can also affect the eye muscles and how well they control the movement of the eyes. This can result in misaligned eyes (strabismus) and double vision (diplopia).

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Complications & Risks of Scleral Buckling

Overall, scleral buckle surgery for the repair of retinal detachments and vision restoration produces positive results. However, complications can occur, and there are risks linked with surgery. While complications are rare, they may be severe.

In some cases, patients may lose sight of the affected eye or lose the whole eye.

If you have had previous eye surgery and existing scar tissue, this surgery may not initially repair a retinal detachment. You may have to repeat the procedure, and your eye doctor must remove existing scar tissue before proceeding. Scar tissue, even pre-existing scar tissue, may affect the retina’s reattachment.

Scarring and infection are the most common complications.

Other risks and complications linked with scleral buckling include:

  • Infection
  • Double vision
  • Cataracts
  • Bleeding
  • Glaucoma
  • Repeated detachment
  • New retinal tears
  • Vitreous hemorrhage
  • Becoming more nearsighted

Speak with your doctor immediately if you experience any bleeding, fever, increased pain, swelling, or decreased vision.

Scleral Buckle Recovery Time & Aftercare

Recovery time from scleral buckle surgery is anywhere from two to four weeks. Your doctor will give you aftercare instructions following surgery. This includes information on when you can start retaking prescription medications and instructions for medication prescribed for post-surgery pain.

Days 1 to 2

You can typically return home on the day of surgery, but you will need someone to drive you. You should expect some pain in the hours or days after the surgery. Your pain level may lessen within a few days, but you will continue to experience redness, tenderness, and swelling for a few weeks following surgery.

You will also need to wear an eye patch for a couple of days following surgery and apply antibiotic eye drops to prevent infection. You must apply eye drops for up to six weeks following surgery.

Days 2 to 3

Swelling can occur after scleral buckling surgery. Your doctor may recommend you place an ice or cold pack over the eye for ten to 20 minutes at a time to lessen swelling. Wrap the ice pack around a clean towel before setting it on your skin.

Some doctors suggest applying an ice pack during the first three days following surgery, around every one to two hours.

Days 3 to 14

Wait for your eye to heal before engaging in strenuous activity. During this period, avoid exercise, cleaning, and heavy lifting. Your doctor may also suggest limiting the amount of reading to prevent too much eye movement.

Weeks 2 to 5

Some people can go back to work after two weeks. But this depends on how you feel and the nature of your work. You should stay at home longer if your role involves heavy lifting or a lot of computer work.

Weeks 6 to 8

Meet with your doctor for a follow-up eye exam. Your doctor will check the condition of the surgical spot to determine how well you are healing.

Your doctor will also assess if there is any improvement in sight. They may recommend corrective lenses or a new eyeglass prescription.

Here are a few do’s and don’ts following a scleral buckling procedure:

  • Do not drive until your doctor gives you permission
  • Do take your prescription medication as instructed
  • Do not exercise or lift heavy objects
  • Do avoid rapid eye movements until you follow up with your doctor
  • Do wear sunglasses during the day
  • Do not get soap in your eye when showering or washing your face. You can wear swim goggles to protect your eyes.
  • Do not lie on your back while sleeping (unless advised otherwise by your surgeon)
  • Do not travel on an airplane until your eye heals. Altitude changes can lead to too much eye pressure

Vision Results After Scleral Buckle Surgery

Scleral buckle surgery reattaches the retina in most cases. The chances for good vision following surgery are higher if the macula was still attached before surgery.

If your detachment affected the macula, good vision following scleral buckling is still possible but less likely.

How Much Does a Scleral Buckle Procedure Cost?

Scleral buckling is likely to cost around $3,000 to $5,000 in total. This includes surgical costs, anesthesia fees, and hospital charges.

Typically, the cost of this surgery is at least partially covered by health insurance. This is because retinal detachment is a medical emergency.

Resources
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Noori, Jila et al. “SCLERAL BUCKLE SURGERY FOR PRIMARY RETINAL DETACHMENT WITHOUT POSTERIOR VITREOUS DETACHMENT.” Retina (Philadelphia, Pa.) vol. 36,11 (2016): 2066-2071

Alexander, P et al. “Scleral buckling combined with vitrectomy for the management of rhegmatogenous retinal detachment associated with inferior retinal breaks.” Eye (London, England) vol. 22,2 (2008): 200-3

Park, Sung Who et al. “Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment.” Korean journal of ophthalmology : KJO vol. 31,4 (2017): 328-335. doi:10.3341/kjo.2016.0024

Retinal Detachment, National Eye Institute (NEI), December 2020

Scleral Buckling, University of Rochester Medical Center, Health Encyclopedia  

Papakostas, Thanos D, and Demetrios Vavvas. “Postoperative Complications of Scleral Buckling.” Seminars in ophthalmology vol. 33,1 (2018): 70-74. doi:10.1080/08820538.2017.1353816

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