14 Apr Scleral Buckle Surgery for Retinal Detachment
A scleral buckle is one of several ways to “fix” a retinal detachment. Other ways include vitrectomy eye surgery as well as a combination of scleral buckle and vitrectomy. An office procedure, called pneumatic retinopexy, is sometimes used as well.
Scleral Buckles are “Oldies But Goodies”
The scleral buckle has been employed for about 75 years. The principle behind a scleral buckle is to cause the shell of the eye, or sclera (the white “wall” of the eyeball) to indent, or “buckle.” The most common way to achieve “buckling” is by oversewing a thick piece of silicone rubber or sponge around the eye or encircling the eye with a silicone band and pulling it tight (same as a belt “buckle”).
The longevity of the scleral buckle implies, at least to me, that it is inherently very good surgery. It corrects the principal problem – relieving “pulling” on the retina.
Pretend You Are Sitting inside Your Eye
The result of any scleral buckle is to reduce the internal diameter of the eye. In doing so, the vitreous can no longer pull on the retina. The cause of a retinal detachment is a retinal tear (or retinal hole).
For example, suppose the room in which you are sitting is the eye and you are the vitreous. The wallpaper of the room is the retina. Stretch your arms apart and pretend you can reach from one wall to the other. Your fingertips are glued to the wallpaper. This is how the vitreous adheres to the retina.
If you move to the left, your right arm now pulls on the wallpaper (or the retina) and you cause a tear on the right side. Similarly, if you move to the right, you create pulling, or traction, on the left wall and cause a tear.
By placing a scleral buckle around the eye, the internal diameter is reduced. This would be the same as moving the walls of the room closer and, as a result, your arms would bend and create slack in the “vitreous.” You could move left or right with less pulling on the wallpaper, and less likely to cause a retinal tear.
Same with the retina!
“Side Effects” of a Scleral Buckle
Side effects, or possible complications, of scleral buckle surgery include;
- increased myopia (you will be more nearsighted) – due to the increased length of the eye. There may also be a large change in the refraction due to astigmatism.
- double vision – uncommon, but the buckle is placed outside of the eye and underneath the eye muscles. By manipulating the eye muscles, double vision is possible.
- pain – usually not an issue and is usually (in my experience) amenable to Tylenol/Advil.
Fun Facts About Scleral Buckles
- The eye is not taken out. We wouldn’t be able to put it back in.
- The “buckle” is usually made of silicone rubber (different than silicone oil) and has no known systemic side effects. It can also be made of a silicone sponge material. These, too, are safe.
- The “buckle” is intended to be permanent. At times, it may extrude, but it is very uncommon. The buckle only really needs to be in place for a couple of months, but we usually never plan on removing them.
- Some surgeons use metal clips to help fasten the buckle around the eye. This can be a problem if future MRI’s are needed.
What Does This Mean?
Though “old,” scleral buckles are not obsolete.
There has been a shift in practice patterns among retina surgeons over the past 15 years. About 15 – 20 years ago, pneumatic retinopexy was first described (aka invented). Scleral buckles with vitrectomy became popular in certain areas of the country and, more recently, vitrectomy alone has become popular.
As I’ll explain in the next few posts, vitrectomy surgery has become instrumental for the repair of retinal detachment, but there is still a role for scleral buckling.
I believe it to be a very valuable tool for retinal detachment surgery, but their use is sometimes based upon the length of time a surgeon takes to perform that part of the operation. It can take a matter of minutes…to hours.