Scleral buckling is a surgical procedure that treats retinal detachment, a serious eye condition. It reattaches the retina to the back of the eye, helping restore or preserve vision. It involves placing a silicone band on the outside of the eyeball to gently push the eye wall inward, providing support to the detached retinal tissue.
Understanding Retinal Detachment
The retina is a thin layer of light-sensitive tissue located at the back of the eye, responsible for converting light into electrical signals sent to the brain. When this tissue pulls away from its normal position, it is known as retinal detachment. This separation cuts off the retina’s blood supply, which can cause vision loss if not addressed promptly.
Retinal detachment often occurs as a natural part of aging, where the vitreous, a gel-like substance filling the eye, changes in consistency and may pull on the retina. Risk factors include severe nearsightedness, previous eye surgeries such as cataract removal, eye trauma, and certain eye disorders like uveitis. Symptoms often appear suddenly and include an increase in “floaters” (tiny specks or lines drifting in vision). Flashes of light, known as photopsia, and a shadow or “curtain-like” effect obstructing part of the vision, particularly peripheral vision, are also common indicators.
The Scleral Buckling Procedure
Scleral buckling involves placing a silicone band or sponge on the sclera, the white outer layer of the eye, to gently indent the eyeball. This indents the eyeball, bringing it closer to the detached retina and allowing reattachment. The type of buckle used can vary, sometimes encircling the entire eyeball or being a smaller segment placed only over the detached area. The buckle is typically sewn onto the eye and often remains in place permanently.
The procedure is usually performed as an outpatient surgery. Anesthesia is administered, which can be general anesthesia, putting the patient to sleep, or local anesthesia to numb only the eye while the patient remains awake. Before the surgery, eye drops are used to dilate the pupil, making the back of the eye more visible to the surgeon. An instrument called a speculum is used to keep the eye open during the procedure.
To prepare the eye, the conjunctiva, a transparent covering over the sclera, is peeled back to expose the sclera. Once the scleral buckle is positioned, additional treatments often seal retinal tears and prevent further detachment. These may include cryopexy, which uses extreme cold to freeze the tissue around a tear, or laser photocoagulation, which uses a laser to create scar tissue that seals the tear. Sometimes, fluid that has accumulated behind the detached retina is also drained during the procedure. Surgery usually takes 1 to 2 hours, though complex cases might take longer.
Recovery and Post-Operative Care
Following scleral buckling surgery, patients typically wear an eye patch and shield for at least a day. The eye may appear red, swollen, or bruised, and some mild discomfort, aching, or a scratchy sensation is common for a few days. Over-the-counter pain relievers can help manage this discomfort.
Patients are usually prescribed antibiotic eye drops to prevent infection and anti-inflammatory drops, which may need to be used for several weeks. Avoid strenuous activities, heavy lifting (over 30 pounds for about two weeks), and bending below the waist during the initial recovery period to prevent increased eye pressure. While light work may be possible within one to two weeks, jobs involving significant physical exertion or extensive computer use might require a longer recovery time.
Vision recovery is gradual, with initial blurriness that improves over several weeks. Follow-up appointments monitor the healing process and assess vision improvement. Patients are advised to use a protective eye shield at night for about a week to prevent accidental trauma during sleep. Avoiding activities like swimming and preventing soap or shampoo from entering the eye during washing are also generally recommended.
Potential Complications and Considerations
While effective for reattaching the retina, scleral buckling, like any surgery, carries potential risks. These can include infection within the eye, bleeding, or an increase in eye pressure (glaucoma). Some patients may experience double vision (diplopia) or develop cataracts, a clouding of the eye’s natural lens.
Changes in refractive error, such as increased nearsightedness, can also occur after the procedure. Rarely, the scleral buckle itself might move or extrude, potentially requiring further surgical intervention. Although the procedure is generally successful, there is a possibility of another retinal detachment or the formation of new retinal tears. Patients are advised to contact their healthcare provider immediately if they experience worsening pain, increased swelling, new or worsening blurry vision, or any new flashes of light or floaters after surgery.