SCLERAL BUCKLING
SCLERAL BUCKLING
Overview
Scleral buckling is a surgical procedure used to repair a retinal detachment. The scleral, or the white of the eye, is the outer supporting layer of the eyeball. In this surgery, a surgeon attaches a piece of silicone or a sponge onto the white of the eye at the spot of a retinal tear. The buckle is designed to repair retinal detachment by pushing the sclera toward the retinal tear or break.
The retina is a layer of tissue on the inside of the eye. It transmits visual information from the optic nerve to your brain. A detached retina shifts from its normal position. If left untreated, retinal detachment can cause permanent loss of vision.
Sometimes, the retina doesn’t completely detach from the eye, but instead forms a tear. Scleral buckling can sometimes be used to repair retinal tears, which can prevent retinal detachment.
Scleral buckling surgery is a common way to treat retinal detachment. It is a method of closing breaks and flattening the 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.
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.
Scleral buckling is used to treat different types of retinal detachments. Retinal detachment is a medical emergency requiring immediate medical care. Scleral buckling is one of the treatment options. Signs of detachment include an increase in the number of eye floaters. These are small tiny specks that can be seen in your field of vision. You may also have flashes of light in your field of vision, and reduced peripheral vision.
How does scleral buckling work?
Scleral buckling takes place in a surgical setting. Your doctor may give you the option of general anaesthesia where you’ll sleep through the procedure. Or your doctor may allow you to remain awake.
Your doctor will provide specific instructions beforehand so you can prepare for the procedure. You’ll likely be required to fast before surgery and avoid eating after midnight on the day of surgery. Your doctor will also provide information as to whether you need to stop taking certain medications.
Here is what you can expect during surgery:
- You’ll receive anaesthesia before surgery and fall asleep. If you’re remaining awake during your surgery, your doctor will apply eye drops or give you an injection to numb your eye. You’ll also receive eye drops to dilate your eyes. Dilation widens your pupil, allowing your doctor to see the back of your eye.
- Your doctor will make an incision to the outer layer of your eye (sclera).
- A buckle or sponge is then stitched around this outer layer of the eye and surgically sewn in place so that it doesn’t move. Buckling is designed to support the retina by pushing the scleral toward the middle of the eye, which can reattach your retina and close retina tears.
- To prevent a tear or detachment from reopening. Your doctor may also perform one of the following:
- Laser photocoagulation. In this procedure, your doctor uses a laser beam to burn the area surrounding a retinal tear or detachment. This creates scar tissue, which helps seal a break and stops fluid leakage.
- Cryopexy. In this procedure, your doctor uses extreme cold to freeze the outer surface of the eye, which can cause scar tissue to develop and seal a break.
- After surgery, your doctor drains any fluid behind your retina and applies antibiotic eye drops to prevent infection.
Scleral buckling is often permanent. But if you have minor retinal detachment, your doctor may use a temporary buckle that can be removed once the eye heals.
Recovery time for scleral buckling
Scleral buckling can take about 45 minutes to complete. Recovery time is anywhere from two to four weeks. Your doctor will provide aftercare instructions. This includes information on when you can resume taking prescription medications, as well as instructions for medication prescribed to treat post-surgery pain.
Day 1 through 2
You will usually be able to go home the day of surgery, but you’ll need someone to drive you.
Expect some pain in the hours or days following the procedure. Your pain level may decrease within a few days, but you’ll continue to have redness, tenderness, and swelling for a few weeks after surgery.
You’ll also need to wear an eye patch for a couple of days after surgery and apply antibiotic eye drops to prevent an infection. You will apply eye drops for up to six weeks after surgery.
Day 2 through 3
Swelling can occur after a scleral buckling. Your surgeon may instruct you to place an ice or cold pack over the eye for 10 to 20 minutes at a time to reduce swelling. Wrap the ice pack around a towel before placing it on your skin. Some doctors will recommend applying an ice pack during the first three days after surgery, about every one to two hours.
Day 3 through 14
Allow your eye to heal before engaging in strenuous activity. During this time, avoid exercise, heavy lifting, and cleaning. Your doctor may also limit the amount of reading to alleviate too much eye movement.
Week 2 through Week 4
Some people can return to work two weeks after scleral buckling. This depends on how you feel and the type of work you do. You should stay home longer if your job involves heavy lifting or a lot of computer work.
Week 6 through Week 8
Follow up with your doctor to have your eye examined. Your doctor will check the condition of the surgical spot to gauge how well you’re healing. Your doctor will also check to see if there’s any improvement in sight, and possibly recommend corrective lenses or a new eyeglass prescription for your eyes.
Here are a few do’s and don’ts after having a scleral buckling procedure:
- Don’t drive until your doctor gives you permission
- Do take your prescription medication as instructed
- Don’t exercise or lift heavy objects, and avoid rapid eye movements until you follow up with your doctor.
- Do wear sunglasses during the day
- Don’t get soap in your eye when showering or washing your face. You can wear swim goggles to protect your eye.
- Don’t lie on your back while sleeping
- Don’t travel on an airplane until your eye heals. Altitude changes can create too much eye pressure
Risks and complications of scleral buckling
Scleral buckling poses some short-term and long-term risks. Most of these complications do not happen very often. Risks include the following:
- 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 (a part of the tissue that forms the eyeball) or swelling in the retinal area may delay healing.
- 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.
- 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.
Other risks and complications associated with this surgery include:
- infection
- double vision
- cataracts
- bleeding
- glaucoma
- repeated detachment
- new retinal tears
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 examination 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).
Contact your doctor immediately if you have any bleeding, develop a fever, or if you experience increased pain, swelling, or decreased vision.
What To Think About
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.