Definition: Scleral buckling is the traditional surgery for treatment of retinal detachment. It is generally performed in the operating room under general anesthesia. During the procedure, which is often accompanied by vitrectomy surgery, the surgeon places a silicone band around the outside circumference of the eye. This is called an encircling scleral buckle or band. The purpose of the encircling scleral buckle is to lessen the pulling of the vitreous on the retina. During the surgery, the surgeon may drain the fluid from beneath the retina by making a tiny slit in the sclera, and then making a small puncture into the space under the retina. The fluid under the retina then drains out through the slit in the sclera. The silicone buckle is left on the eye permanently.
Occasionally, the surgeon may place a gas bubble into the vitreous cavity. When the surgery is over, the patient is positioned so that the gas bubble rises and pushes the retina against the scleral buckle to help keep the retina attached to its supporting structures.
In most cases, there is better than 80% chance of successfully reattaching the retina with one operation. But successful reattachment does not necessarily mean restored vision. The return of good vision after the surgery depends on whether, and for how long, the macula was detached prior to the surgery. If the macula was detached, vision rarely returns to normal. Still, if the retina is successfully reattached, vision usually improves. The best vision may not occur for many months after surgery. In many cases, even if the macula was still attached before the surgery, and even if the surgery results in successful reattachment of the retina, some vision may be lost. If the retinal detachment operation fails, a second operation is usually possible.
Following surgery, the eye will be red and slightly sore up to two months. Patients often feel a scratchy sensation produced by the stitches used to close the lining around the eye. Severe pain is uncommon; if it occurs, the surgeon should be told immediately. The eye will water for several weeks. Usually, several medicines given as eye drops must be taken after the surgery to prevent infection and help make the eye feel more comfortable.
Following the surgery, vision will be blurry; it may take many weeks for the vision to improve. During this period the main concern is that the retina remains attached. Restricting a patient’s physical activity is necessary.
Even though the surgery for retinal detachment is generally successful, complications can occur, resulting in failure of the operation, loss of some or all vision, and in rare situations, even loss of the eye.
Retinal detachment surgery done by scleral buckling can affect the eye muscles that move the eye and keep it straight, resulting in diplopia, or double vision. Other complications include bleeding under the retina, cataract formation, glaucoma, retinal re-detachment, proliferative vitreoretinopathy, vitreous hemorrhage, ptosis and infection. Although any one of these can result in the need for more surgery, or the total loss of vision, these complications are very infrequent. Retinal re-detachment is the most commonly occurring problem.