Scleral Buckle Surgery Overview
Scleral Buckle Surgery is one of the techniques used for retinal detachment repair.
The retina is the light sensitive layer which lines the back 2/3 of the eye. The vitreous cavity contains a jelly-like substance called the vitreous gel. The vitreous gel is firmly adherent to most of the retina at birth, but naturally liquefies over the years and shrinks away from the retina. This results in a vitreous separation (vitreous detachment), which can be associated with traction and retinal breaks. Liquid vitreous can flow through the breaks, and under the retina, causing separation from the eye wall causing a retinal detachment.
During scleral buckle procedure, the retinal breaks are identified and treated with cryotherapy and/or laser. A solid silicone rubber band or piece is then sutured to the tough, white coat of the eye (the sclera). This silicone piece causes indentation of the eye wall against the retinal breaks, which closes the retinal breaks and releases the inner traction caused by the vitreous. Subretinal fluid is sometimes externally drained from the eye, and occasionally, sterile gas is injected into the eye to help hold the retina in position.
The macula is the central portion of the retina and is responsible for reading vision. If the macula was still attached before surgery, chances for good vision after surgery are very good. If the retinal detachment involves the macula, there may be irreversible loss or only partial recovery of vision, so the extent of visual improvement following surgery cannot be predicted preoperatively.
New or recurrent retinal detachments can arise because of new retinal breaks or persistent pulling by the vitreous gel on the retina. In about 10% of patients scar tissue grows along the surface, within, or beneath the retina, causing the retina to detach. This growth, or proliferation of scar tissue is known as Proliferative Vitreo-Retinopathy (PVR).
The development of scar tissue membranes has a poor prognosis and patients require additional surgical procedures, including vitrectomy (removal of the vitreous gel), membrane peeling and retinal reattachment. Subsequent surgery for PVR has about a 65-75% success rate. If the scar tissue develops within the macula (macular epiretinal membrane or macular pucker), additional surgery, vitrectomy and membrane peeling, can be done to remove the scar tissue.
What to Expect During Scleral Buckle Surgery
In most cases, you will need medical clearance and laboratory testing prior to surgery. Your doctor will instruct you if you need to stop taking certain medications prior to the operation. Some eye drops are sometimes started prior to the day of surgery.
You must be fasting on the day of surgery. The surgery is performed under either local anesthesia with sedation or general anesthesia. The anesthesiologist will discuss the various options, as well as the risks and benefits of the different types of anesthesia, prior to surgery. A first-time surgery usually takes 1 to 2 hours. Repeat surgeries or more complicated cases may take longer. The surgery is usually ambulatory. After surgery, a patch will remain in place until the next day, unless you are instructed otherwise.
Scleral Buckle Surgery Recovery
After surgery, you will be instructed regarding the care of your eye, positioning of your head, medications, diet, and limitation of activities. You should understand that if a long acting gas is used, you cannot travel in an airplane, travel to a high altitude or breathe certain types of gases or inhalation anesthesia for one to two months after your vitreous surgery. You must wear the medical alert bracelet that was given at the hospital that indicates you have a gas bubble in you eye until the bubble has been completely resorbed.
In the first follow up visit, the day after surgery, the patch is removed, and the eye will be checked in our office. Instructions, including the use of eyedrops and positioning, will be given. You may experience headaches or ocular discomfort and perhaps bloody tears for several days, possibly a week or more following surgery.
Some degree of eye pain is normal after surgery, especially in the first 2 to 3 days, but it is usually manageable with over the counter analgesics. It is normal to have blurry vision and some swelling in the first month or so after surgery as the eye recovers. It is important to keep your follow up appointments and follow all the instructions, the success of the surgery also depends on that. The visual improvement following surgery takes several months and usually requires a change in refraction (eyeglass or contacts prescription).
Scleral Buckle Risks and Complications
Any surgical procedure has certain associated risks, and your surgeon will do everything possible to minimize these risks. The complications of standard retinal detachment surgery include failure to reattach the retina, bleeding, infection, inflammation of the eye, increased eye pressure, cataract formation and corneal abrasion or edema.
There may be extrusion (exposure of the buckle), distorted or poor central vision, double vision, ptosis (droopy lid), scarring of the conjunctiva (mucous membrane covering the eye), and in rare cases, loss of the eye. It may be necessary to perform additional procedures such as laser, gas injections (performed in the office), or additional surgery, such as revision of the scleral buckle or pars plana vitrectomy.
Always call us immediately if you are experiencing problems, especially decrease in vision, worsening pain or worsening inflammation, or any new floaters, flashes or changes in your peripheral field of vision. You can also call us with any questions.
Scleral Buckle Surgery: Frequently Asked Questions
The scleral buckle is usually left in place and once the retina completely heals it will have a permanent effect in maintaining the retina attached and preventing further traction or re-detachments.
Usually not as it is placed behind the extraocular muscles that control the eye and then covered by tenons and conjunctiva (the skin over the white part of the eye).
Anatomical success rate is approximately 90%, which is as high as you can get compared to other reattachment techniques.
Yes, it will be permanent, unless there is an unlikely exposure and/or infection in which it has to be removed. The silicone material is solid, inert, and it does not leak or spread into the body, it causes no reactions.
Without intervention there is usually progression of detachment and loss of all vision. There are only few methods to repair a detached retina. The chances of each type of procedure to work varies on each case. The location, extent, cause and type of detachment are factors the surgeon considers in determining which procedure may work best for your particular case. Other problems or eye conditions may be factors that are considered as well. Laser and cryopexy can be used alone for retinal breaks either in attached retina or in those associated with very small retinal detachments. Pneumatic retinopexy (gas injection into the vitreous cavity) can be used for retinal detachments associated with one or more retinal breaks in close proximity to each other, in the upper half of the eye. A vitrectomy (removal of the vitreous gel) may be necessary in cases of a complicated retinal detachment, such as a retinal detachment associated with a giant retinal break or Proliferative Vitreo-Retinopathy (PVR). Vitrectomy can also be used to repair uncomplicated retinal detachments.
Choose Vitreoretinal Consultants of NY for Scleral Buckle Surgery in Queens and Long Island
At Vitreoretinal Consultants of NY, we are dedicated to providing our patients with exceptional retinal care. For us, nothing is as important as your eyesight. Contact us with any questions, or schedule an appointment with VRC today.