The scleral buckle is a surgical technique used to treat retinal detachment, a serious condition that can lead to permanent vision loss. This procedure involves placing a small, flexible band or sponge, typically made of silicone, onto the outer white wall of the eye, known as the sclera. The device gently pushes the scleral wall inward, creating an indentation that supports the detached retina and helps it reattach to the underlying tissue. This time-tested method relieves the forces that caused the retina to separate, helping to restore vision.
Understanding Retinal Detachment
The retina is a thin layer of specialized nerve tissue lining the inside back two-thirds of the eyeball. It captures light and converts it into electrical signals sent to the brain for interpretation as vision. Retinal detachment occurs when this light-sensitive layer separates from the underlying supportive tissue, which supplies oxygen and nourishment. This separation is a medical emergency because the detached retina is deprived of its blood supply, leading to rapid dysfunction and potential permanent vision loss.
The most common form, rhegmatogenous retinal detachment, is caused by a tear or hole in the retina. Fluid from the vitreous cavity, the gel-like substance filling the eye, can seep through this break and accumulate beneath the retina, causing it to peel away. Aging is a frequent factor, as the vitreous gel naturally liquefies and shrinks, sometimes pulling on the retina and causing a tear. Symptoms often include a sudden increase in floaters, flashes of light (photopsia), or a dark shadow moving across the field of vision.
Mechanism of the Scleral Buckle
The scleral buckle is a solid, non-absorbable material, typically silicone rubber or sponge, that is surgically secured to the sclera. It may be a localized segment placed over the tear area or an encircling band around the entire circumference of the eye. Once sutured, the buckle creates an inward indentation of the eye wall, pushing the outer layers closer to the detached retina. This inward push physically closes the retinal tear and reduces the tractional pull exerted by the vitreous gel.
By bringing the tissues closer, the buckle allows the accumulated subretinal fluid to be reabsorbed by the body. The surgeon nearly always complements the buckle with retinopexy to permanently seal the tear. This sealing is done using cryotherapy (freezing) or laser photocoagulation (heating) applied to the outside of the eye over the tear location. This process creates a controlled, long-lasting scar that forms a secure adhesion between the retina and the underlying supporting tissue.
The Surgical Process and Immediate Post-Operative Care
Scleral buckling is typically performed in an operating room, often as an outpatient procedure. The patient receives anesthesia, which may be local with sedation or general anesthesia. The surgeon makes a small incision in the conjunctiva to access the sclera. The eye muscles are isolated so the silicone buckle or band can be placed beneath them and secured to the sclera with fine sutures.
During the procedure, the retinal tear location is identified, and the complementary sealing treatment, such as cryotherapy, is applied. In many cases, the surgeon drains the subretinal fluid to flatten the retina completely before finalizing the buckle placement. Once the buckle is secured and the retina is flat, the conjunctiva is closed, and an antibiotic is applied to prevent infection. Immediately after surgery, the eye is usually patched, and patients experience some soreness, swelling, and temporarily blurred vision.
Patients are instructed to use prescription eye drops, including antibiotics and anti-inflammatory medications, for several weeks to support healing. Activity restrictions are necessary; patients must avoid strenuous activities, heavy lifting, and bending over, which could increase eye pressure. A follow-up appointment is scheduled for the day after the procedure to confirm the retina remains attached. If a gas bubble was injected, strict head positioning is required to ensure the bubble exerts proper pressure.
Living with a Scleral Buckle and Potential Complications
The scleral buckle is designed to be a permanent implant and remains in place indefinitely for the vast majority of patients. It is positioned beneath the eye muscles and the conjunctiva, making it virtually invisible and unnoticeable once initial healing is complete. Long-term visual recovery depends on whether the macula was detached before surgery and the duration of the detachment. Reattachment success rates are high, often around 90% after one operation, though vision may continue to improve gradually over several months.
While the buckle provides stable support, its presence can sometimes lead to long-term issues requiring monitoring. A common consequence is a change in the eye’s shape, which can induce or increase nearsightedness (myopia) or astigmatism, often requiring updated corrective lenses. Although rare, serious complications include infection of the buckle material or the buckle moving out of position (extrusion or migration), which may necessitate its removal years later. Double vision (diplopia) or eye misalignment (strabismus) is another potential complication due to the buckle’s proximity to the eye muscles.
Follow-up care involves regular check-ups with an ophthalmologist to monitor the stability of the retina and the status of the buckle. Should the buckle need removal due to chronic pain, infection, or exposure, studies indicate a high rate of symptom resolution and a low risk of the retina re-detaching.