Scleral buckling surgery is a widely used and highly effective treatment for retinal detachment, a serious eye condition that can lead to permanent vision loss if not addressed promptly. This surgical procedure has been a standard treatment for decades and remains a preferred choice in certain types of retinal detachment cases, especially those caused by retinal tears or holes.
One of the most established and successful treatments for retinal detachment is scleral buckling surgery. Used for several decades with a proven track record, this procedure involves placing a silicone band or sponge on the outer wall of the eye to gently push the eye wall inward, allowing the retina to reattach and heal. Despite the introduction of newer surgical techniques like vitrectomy and Retinal detachment, scleral buckling continues to be a preferred method, especially in younger patients and those with specific types of retinal tears.
What is Scleral Buckling Surgery?
Scleral buckling is a retinal reattachment surgery designed to treat rhegmatogenous retinal detachment—a type of detachment caused by a tear or break in the retina. The goal of the surgery is to close the retinal break and reattach the retina to the underlying layers of the eye.
During this procedure, a silicone band or sponge (called a scleral buckle) is sewn onto the white part of the eye (the sclera). This band pushes the wall of the eye inward, allowing the detached retina to settle back into its correct position. Often, cryotherapy (freezing) or laser photocoagulation is used in conjunction to seal the tear and promote retinal healing.
Who Needs Scleral Buckling Surgery?
Scleral buckling is typically recommended for :-
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Patients with retinal detachment caused by a retinal tear.
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Individuals with multiple retinal breaks.
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Patients who are young and phakic (have their natural lens intact).
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Those who are not suitable candidates for vitrectomy due to eye structure or general health.
This surgery may be combined with other treatments like vitrectomy or pneumatic retinopexy, depending on the severity and complexity of the retinal detachment.
Symptoms of Retinal Detachment
Recognizing the signs of retinal detachment early is crucial for preserving vision. Common symptoms include :-
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Sudden appearance of floaters (dark spots or strings in vision)
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Flashes of light in one or both eyes
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A shadow or curtain-like vision loss
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Gradual reduction in peripheral (side) vision
If you experience any of these symptoms, consult an ophthalmologist immediately.
Pre-Surgical Evaluation and Diagnosis
Before scleral buckling surgery, a thorough eye examination is performed. This includes :-
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Dilated retinal examination
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Ultrasound of the eye (if retina cannot be visualized due to bleeding)
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Optical coherence tomography (OCT)
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Visual acuity tests
The ophthalmologist will assess the size, location, and number of retinal tears to determine the best surgical approach.
Treatment for Scleral Buckling Surgery : Step-by-Step
Here’s a breakdown of what to expect during scleral buckling surgery :-
Anesthesia
The surgery is usually performed under local anesthesia with sedation or, in some cases, general anesthesia.
Locating the Retinal Tear
The surgeon identifies the tear using a scleral depressor and indirect ophthalmoscope.
Sealing the Tear
Cryopexy (freezing treatment) or laser photocoagulation is applied to seal the retinal tear and initiate scar formation, which holds the retina in place.
Placement of the Buckle
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A silicone band (buckle) is sewn onto the sclera around the eye’s circumference.
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The buckle gently pushes the wall of the eye inward, supporting the retinal layer to reattach properly.
Drainage of Sub retinal Fluid (if necessary)
In some cases, fluid beneath the retina may be drained to allow it to lie flat against the wall of the eye.
Closing the Eye
The eye is stitched closed, and a protective eye patch is applied.
Duration of the Surgery
Scleral buckling typically takes about 1 to 2 hours, depending on the complexity of the detachment.
Postoperative Recovery and Care
Hospital Stay
Most patients go home the same day, though some may require an overnight stay for monitoring.
Eye Care
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Eye drops (antibiotic and anti-inflammatory) are prescribed.
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An eye shield may be worn to protect the eye during sleep.
Positioning
In some cases, patients are advised to maintain a specific head positioning to aid healing.
Vision Changes
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Vision may initially be blurry but gradually improves over several weeks.
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Full recovery can take up to 6–8 weeks.
Expected Results and Success Rate
Scleral buckling surgery has a high success rate, with 85–90% of initial procedures resulting in successful retinal reattachment. Even in recurrent detachments, repeat surgeries can often restore vision.
Patients typically regain usable vision, though the final outcome depends on :-
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Duration of detachment before surgery
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Location of detachment (macula-on vs. macula-off)
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Overall eye health
Risks and Complications
As with any surgery, scleral buckling carries some risks, including :-
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Infection
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Bleeding
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Double vision (diplopia)
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Cataract formation
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Increased intraocular pressure (glaucoma)
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Re-detachment of the retina
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Myopia (nearsightedness) due to the buckle changing eye shape
However, these complications are relatively rare and manageable when detected early.
Long-Term Outlook and Lifestyle Tips
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Regular follow-ups are crucial to monitor retinal health and check for recurrence.
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Protect your eyes from trauma and UV light.
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Control underlying health conditions like diabetes and hypertension.
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Avoid high-impact activities for several weeks post-surgery.
Most patients return to normal life activities, including work and driving, within 4 to 6 weeks after full recovery.
Conclusion
Treatment for scleral buckling surgery remains a trusted and time-tested solution for retinal detachment, offering high success rates and favorable visual outcomes. With advancements in surgical techniques and postoperative care, the prognosis for patients undergoing this procedure continues to improve.
