Scleral buckling surgery is a time-tested procedure used to treat retinal detachment, a serious eye condition that can lead to vision loss if not addressed promptly. Though newer procedures like vitrectomy and pneumatic retinopexy are also available, scleral buckling remains a trusted approach, especially for certain types of retinal detachment. But what exactly causes someone to need this surgery?
Scleral buckling is a well established surgical technique that has been successfully used for decades to reattach the retina and preserve vision. While newer, minimally invasive treatments such as vitrectomy and pneumatic retinopexy are increasingly popular, scleral buckling remains a preferred choice in specific scenarios especially for younger patients, those with certain types of retinal breaks, or when retinal tears are located in the peripheral areas of the eye.
What Is Scleral Buckling Surgery?
Scleral buckling is a surgical procedure used to repair a detached retina, a condition where the thin layer of tissue at the back of the eye pulls away from its normal position. During the procedure, a silicone band (called a scleral buckle) is sewn onto the white of the eye (the sclera) to push the wall of the eye inward. This relieves the traction on the retina, allowing it to reattach and heal.
Why Is Scleral Buckling Performed?
The primary reason for scleral buckling surgery is rhegmatogenous retinal detachment, which occurs due to a tear or break in the retina. This tear allows fluid to pass through and accumulate behind the retina, causing it to lift away from the underlying supportive tissue. The surgery helps close the break and reposition the retina.
But what causes the retina to tear in the first place? Let’s look at the common causes that lead to scleral buckling surgery.
Posterior Vitreous Detachment (PVD)
One of the most common causes of retinal detachment is posterior vitreous detachment. The eye is filled with a gel-like substance called vitreous humor, which shrinks and changes consistency as we age. This shrinking can cause the vitreous to pull away from the retina.
In some cases, the vitreous pulls too hard and causes a retinal tear, especially in people with weak retinal tissue. If fluid from the vitreous seeps through the tear, it can cause the retina to detach. This is a major reason why scleral buckling surgery may be required.
High Myopia (Severe Nearsightedness)
People with high myopia are at greater risk of retinal detachment. In highly myopic eyes, the eyeball is longer than normal, stretching the retina and making it thinner and more fragile. This makes it more susceptible to tears, holes, or breaks.
Due to this vulnerability, individuals with high myopia are often candidates for preventive retinal exams, and if a tear or detachment is identified, scleral buckling may be recommended as a treatment option.
Eye Injuries or Trauma
Blunt trauma or penetrating injury to the eye can result in retinal tears or detachments. The sudden force from an accident or sports injury may cause the retina to separate from the underlying tissue. In many traumatic cases, scleral buckling surgery is used to repair the damage and restore vision.
Sports injuries, car accidents, or even complications during certain eye surgeries (like cataract removal) can all be linked to traumatic retinal detachment.
Lattice Degeneration
Lattice degeneration is a condition where parts of the retina become thin and weak, forming a lattice-like pattern. This condition increases the risk of retinal tears, especially if traction occurs from the vitreous.
Many patients with lattice degeneration don’t develop retinal detachment, but in some, the thinning is severe enough to lead to tearing. When a detachment occurs, scleral buckling may be advised, particularly if the location and nature of the detachment are suitable for this surgical method.
Family History and Genetics
Genetic factors can also play a role in increasing a person’s risk of retinal detachment. If you have a family history of retinal issues or retinal detachment, you may be more prone to developing it yourself. Certain inherited conditions like Stickler syndrome or Marfan syndrome are also associated with a higher risk.
In patients with a genetic predisposition, retinal detachment may occur at a younger age, and scleral buckling is often used to restore normal retinal positioning.
Previous Eye Surgeries
People who have undergone previous eye surgeries, especially cataract extraction, may be at increased risk of developing a retinal tear or detachment. The risk is particularly higher if complications occurred during surgery, such as posterior capsule rupture.
Scleral buckling remains an effective technique to repair retinal detachment caused by such surgical complications, especially when the retinal breaks are located in the peripheral retina.
Inflammatory Conditions of the Eye
Certain inflammatory eye conditions, such as uveitis, can cause damage to the retina and increase the chances of detachment. Chronic inflammation can weaken the retinal tissue or cause scarring that exerts traction on the retina.
Although not a common cause, when inflammation leads to retinal detachment, scleral buckling may be considered depending on the nature of the retinal break.
Pediatric or Congenital Retinal Detachment
In rare cases, children may be born with or develop retinal detachments due to congenital conditions such as retinopathy of prematurity or coloboma. Pediatric retinal detachments are complex and often require surgical repair.
Scleral buckling is sometimes the preferred method in such pediatric cases, especially when the detachment is caused by a single or few retinal breaks.
Signs and Symptoms of Retinal Detachment
Recognizing the early symptoms of retinal detachment is crucial in seeking prompt treatment and preventing permanent vision loss. Common signs include :-
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Sudden appearance of floaters in your vision
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Flashes of light in one or both eyes
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A shadow or curtain over a portion of your visual field
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Blurred or reduced vision
If you notice any of these symptoms, consult an eye specialist immediately. Early diagnosis can improve the success rate of scleral buckling surgery or other interventions.
When Is Scleral Buckling Preferred Over Other Treatments?
While newer techniques like pars plana vitrectomy are commonly used today, scleral buckling remains highly effective in certain cases, particularly :-
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Younger patients with clear natural lenses (phakic eyes)
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Retinal detachments caused by a single or few retinal breaks
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Tears located in the peripheral retina
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Patients who cannot undergo vitrectomy due to other health conditions
In some cases, scleral buckling may even be combined with vitrectomy for complex retinal detachments.
Conclusion
Understanding the causes that lead to scleral buckling surgery is crucial in protecting your vision and taking preventive measures. Whether due to aging, trauma, myopia, or genetic predisposition, any risk of retinal detachment should be taken seriously. Early detection and timely treatment with procedures like scleral buckling can significantly improve outcomes and preserve vision.
