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Scleral buckling surgery for retinal detachment

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

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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 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.

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Other facts about the surgery

The surgery usually takes place in a hospital. Detachments can usually be repaired on an Read the My WebMD: Learning to
outpatient basis (you go home the same day) in the hospital or in an outpatient surgical
Live With Blindness article > >
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.
www.webmd.com/eye-health/scleral-buckling-surgery-for-retinal-detachment

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Scleral buckling surgery for retinal detachment

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) to help you prepare for this surgery.
Citations
www.webmd.com/eye-health/scleral-buckling-surgery-for-retinal-detachment

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Scleral buckling surgery for retinal detachment

1. American Academy of Ophthalmology Committee on Ophthalmic Procedure Assessment (1996). The repair of
rhegmatogenous 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

WebMD Medical Reference from Healthw ise

Last Updated: August 07, 2011
This information is not intended to replace the advice of a doctor. Healthwise disclaims any
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