03 Apr Fixing a Retinal Detachment | Retina Specialist, Fairfax, Va.
There are several methods to repair a retinal detachment. None is the best or right method and retina specialists all seem to have their own preferences.
In my opinion, the decision on what procedure(s) to employ depends upon the nature of the retinal detachment, skill of the surgeon and time required to perform the procedure.
Methods for fixing a retina detachment;
1. Scleral Buckle
2. Pneumatic Retinopexy
4. Scleral Buckle and Vitrectomy Combined
This is the oldest method to repair a retinal detachment. It repairs a retinal detachment by placing an “element” outside of the eyeball. The scleral buckle (aka element) may be placed all the way around the eye or partially.
In either case, the goal is to get the sclera, or the wall of the eye, to indent or “buckle” (as in the way a road may buckle). This buckling causes a decrease in the internal diameter of the eye thereby reducing traction, or pulling, on the retina by the vitreous.
Advantages of Scleral Buckle
Fewer Redetachments – after the initial operation, because stress is reduced in the vitreous, it becomes much more difficult for the vitreous to pull on the retina and cause additional tears.
The key to fixing any rhegmatogenous retinal detachment is to locate and treat the causative retinal tears and retinal holes. This is not always easy. Thus, in these complex situations, a scleral buckle may be more effective in preventing recurrent retinal detachment by foreshortening the amount of retina which may re-detach.
Disadvantages of Scleral Buckle
Required Skill – this may be the most difficult operation performed by a retinal specialist. It can be difficult to position the buckle element precisely on the outside of the eye. There is not a lot of space in the small eye socket which holds your eye. This can take some surgeons…hours.
More Side Effects such as near-sightedness, anisometropia, double vision are all related to manipulating the eye and its muscles.
Swelling and Discomfort – quite simply the longer the operation, the more manipulation of the tissues, the more swelling and post-operative discomfort.
My Preferences for Using a Scleral Buckle
I prefer using a scleral buckle;
1. Total retinal or large retinal detachment – with most or all of the retina detached, it is difficult to examine the retina thoroughly when looking for holes or teras. This reduces the chances of my missing a retinal tear, and thus, reduces the chances of re-detachment.
2. I have used the same type of scleral buckle, without exception, for over 15 years. While there are various shapes and sizes, I don’t think it matters very much.
3. I always pass the scleral buckle around the entire eye. This reduces abnormal amounts of astigmatism which may develop with buckles placed in certain segments of the eye. The amount of induced myopia is also easier to estimate as the same procedure is repeated time after time.
4. By using the same buckle and encompassing the entire eye, I am able to complete the operation by minimizing variation and minimizing operating time. My surgical team always knows what I am doing.
This increase in speed and efficiency translates to less surgical trauma to the eye, fewer chances of side effects and quicker recovery.