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 Encyclopedia - Scleral Buckle

What happens during the surgery?
What is the success rate for this procedure?
What care is required after surgery?
What are the possible side effects?

A scleral buckle is the traditional surgical procedure used in repairing a detached retina. A detached retina occurs when a portion of the retina inside the back of the eye comes loose from the underlying epithelium. Because the retina is responsible for receiving and sending visual images to the brain, a detachment can seriously affect vision and should be repaired by a retina surgeon immediately.

There are two types of surgery available for retinal detachments: scleral buckling and pneumatic retinopexy. The scleral buckle is the more common treatment. During this surgery, the sclera (the outside covering or white of the eye) is indented or "buckled" inward, usually by attaching a piece of preserved sclera or silicone rubber to its surface.

What happens during the surgery?

The surgery is usually performed in an operating room under general anesthesia, although local anesthesia may be used in some cases. Because most retinal detachments are caused by a retinal tear, the first step is to repair the tear with either a laser or a freezing instrument known as a cryoprobe. This treatment creates a scar around the tear preventing further tears or detachment. Next, a piece of solid silicone or a silicone sponge is sewn onto the outside wall of the eye over the retinal tear site. The silicone pushes in on the sclera until scarring from the cryotherapy (or laser treatment) seals the tear. The surgery is called scleral buckling because the sclera is buckled (pushed) in by the silicone. This buckle is left on the eye permanently and is not usually visible following surgery.

On occasion, a vitrectomy may also be performed in conjunction with the scleral buckling surgery. During a vitrectomy, the vitreous fluid, which fills the eye, is removed and replaced with air or gas to push the retina back into place. These gases are gradually replaced by new vitreous fluid produced by the eye.

What is the success rate for this procedure?

The success of retina surgery depends on a number of factors including the length of time from when the retina detached until it was repaired, the size and location of the damage, and whether a fibrous growth has formed on the retina. If the macula (portion of the retina responsible for central or reading vision) was detached, vision rarely returns to normal.

In most cases, the retina can be successfully reattached, but reattachment does not necessarily mean restored vision. It may take many months after surgery for the best vision to occur and, if the first retinal detachment operation is not successful, a second operation may be performed. Treatment almost always prevents further loss of sight from this type of retinal problem.

What care is required after surgery?

Following scleral buckle surgery, the eye may be red and sore for a time and vision may be blurry. A scratchy sensation may also be felt as the stitches used to close the lining around the eye heal. The eye may be patched and eye drops given to prevent infection. Physical activity is usually restricted to ensure that the retina remains attached. Regular follow-up visits are necessary to ensure the retina is healing properly.

What are the possible side effects?

Serious complications from scleral buckling surgery are infrequent but can happen. The most common is redetachment of the retina. Occasionally, double vision can result from damage to the muscles that control eye movement. Other rare complications include cataract formation, bleeding beneath the retina, glaucoma, infection, and drooping of the eyelid.

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