What is Scleral Buckling? Overview, Benefits, and Expected Results
Your eyes are a delicate and connected system, with various structures and components working together to keep them healthy and functioning properly. One of these components, the sclera, needs extra special attention at times. If it becomes damaged or weakened in any way, your vision may be affected. Enter scleral buckling, an eye surgery aimed at restoring the structural integrity of the sclera itself.
What is Scleral Buckling?
Also called scleral reinforcement, scleral buckling involves securing a thin, flexible silicone band to the outside of your eye to reinforce the weakened or damaged eye wall. This procedure helps relieve any hydrostatic pressure from retinal vessels, allowing the scar tissue to stop stretching and relax.
The type of scleral buckling often depends on the size and location of the hole in the scleral wall. Depending on the size of the retinal detachment, the surgical procedure consists of one or two buckles secured to the eye’s scleral wall. These buckles come in several varieties, including silicone bands and cryopexy straps, which are bands treated with very cold liquid nitrogen.
Benefits of Scleral Buckling
Having a scleral buckle affixed to the eye wall can have a number of benefits, including:
- Reducing pressure on retinal veins and arteries that connect to the eye, improving blood circulation and vision
- Stabilizing and flattening the scleral wall, improving the focus capabilities of the eye
- Helping prevent further eye damage
- Repairing pivotal eye components, such as a retinal tear or detachment
- Providing support for the eye wall, preventing it from further damage
- Improving the long-term odds of avoiding a second repair for the same issue
Expected Results After Surgery
The results of a scleral buckling procedure are usually immediate, with patients experiencing immediately improved vision in most cases. Most patients also experience improved stability in the eye as well, leading to fewer vision problems in the long term.
Patients can expect some soreness and discomfort following the surgery, but this is usually a sign that the procedure was successful. The Buckle will remain in place for a few months and should not be removed until your doctor or eye care specialist tells you to.
Complications and Risks
Scleral buckling helps to restore the scleral wall, but there are associated risks and potential complications, including:
- Pressure buildup inside of the eye
- Neil blind, a condition where vision is dimmed or lost because of damage to the optic nerve
Your doctor can help determine the best course of action if any of these complications arise.
In general, scleral buckling is a safe procedure and has proven to be successful in restoring vision in many cases. Depending on the severity of the Retinal tear or detachment, there may be other treatments more suitable to the condition. Speak with a qualified eye care provider to discuss if a scleral buckle is the best fit for your vision problems.
التعريف والنظرة العامة
Scleral buckling is one of the traditional treatment methods for retinal detachment, a serious condition that occurs when the retina separates from the surrounding tissue that supports it. The procedure involves sewing a piece of silicone rubber or sponge-like material, called a scleral buckle, on the sclera (white part of the eye) so the retina will settle against the eye wall.
من يجب أن يخضع للنتائج المتوقعة
Scleral buckling is one of the treatment options for patients suffering from retinal detachment, a serious eye disorder in which the retina peels away from the layer of tissue that supports it. It is a slowly progressing disorder, with most cases starting with localised detachment and progressing until the entire retina detaches completely, placing the patient at risk of total vision loss. Thus, scleral buckling is considered as an emergency surgical procedure performed to help prevent blindness.
Symptoms of retinal detachment include:
- Photopsia, or when the patient sees flashes of light
- Floaters, usually in the temporal side of the central vision
- Dense shadow affecting the peripheral vision and moving gradually towards the central vision
- Veiled or curtained vision
- Central vision loss
Retinal detachment commonly affects patients who also suffer from other ophthalmic conditions, such as cataracts and severe myopia. It can also be caused by genetics and trauma to the eye, and can thus also present in various degrees of severity.
Retinal detachment has different types, namely:
- Rhegmatogenous retinal detachment, which is caused by a tear in the retina
- Exudative or secondary retinal detachment, in which the retina becomes inflamed and detaches due to injury or vascular problems
- Tractional retinal detachment, in which fibrovascular tissue applies traction on the retina, causing it to detach
A scleral buckling can be performed at any stage of retinal detachment and is generally effective in reattaching the retina, giving the patient a good chance of regaining good vision. However, the procedure has its limitations and is not known to prevent retinal detachment or protect against recurrences. It is also not helpful in cases of traction detachment, a condition wherein the detachment is caused by scar tissue that tugs on the retina, and in cases wherein the macula has also become detached. Due to these limitations, scleral buckling is not as popular as other treatment options used for retinal detachment such as cryopexy and laser photocoagulation.
كيف يتم إجراء العملية؟
A scleral buckling is performed in an operating room but does not require an overnight stay in the hospital. Anaesthesia, either local or general administered in the form of eye drops or injections, is also necessary to ensure patient’s comfort during the procedure. While waiting for the procedure, the patient’s affected eye is usually patched to prevent the detachment from progressing.
On the day of the procedure, the patient is given dilating eye drops and the surgeon proceeds by sewing fine bands of silicone plastic or sponge onto the sclera where retinal tear or detachment is located. This effectively pushes the sclera toward the tear and causes the retina to reattach. This results in scarring that seals the tear in the retina.
The procedure typically takes one to two hours, but it may take longer in the case of repeat surgeries and complicated detachments.
المخاطر والمضاعفات المحتملة
Scleral buckling is associated with a number of short and long-term risks and possible complications, although they rarely occur. These include:
عدوى – The eyes are vulnerable to infection during the healing process. In order to keep this risk under control, patients are prescribed with antibiotic eye drops, which also help keep the pupil from dilating and constricting.
Proliferative vitreoretinopathy (PVR) – This is a condition wherein scarring forms on the retina, which can cause the retina to become detached again.
Choroid detachment – This occurs when the choroid, a tissue that forms part of the eyeball, also becomes detached, delaying the healing process.
Increased fluid pressure inside the eyeball – This complication most commonly affects patients who also suffer from glaucoma.
Refractive error and vision changes – A scleral buckle can change the shape of the eye, which can result in refractive errors and vision problems.
Strabismus – A scleral buckle can affect the muscles of the eyes. If eye movement is affected, it can cause misaligned eyes.
Diplopia – The presence of a scleral buckle in the eye may also cause double vision.
Symptoms that indicate a possible complication include:
- Increased pain
- Redness and swelling that increase rather than subside
- Abnormal eye discharge
- Any changes in vision
As a preemptive measure, ophthalmologists conduct regular follow-up consultations scheduled on the 1st, 4th, 8th, and 12th weeks after the procedure. This is followed by annual examinations to watch for signs of recurrence.
Schwartz S., Kuhl D., McPherson A. et al. (2002). “Twenty-Year Follow-up for Scleral Buckling.” Arch. Ophthalmol. 2002;120(3):325-329. http://archopht.jamanetwork.com/article.aspx?articleid=269749
Salicone A., Smiddy W., et al. (2006). “Visual Recovery after Scleral Buckling Procedure for Retinal Detachment.” Department of Ophthalmology, Bascom Palmer Eye Institute. http://www.aaojournal.org/article/s0161-6420(06)00693-2/abstract
Dehghani A., Razmjoo H., Fazel F., et al. (2013). “The comparison of retinal blood flow after scleral buckling with or without encircling procedure.” J Res Med Sci. 2013 Mar;18(3):222-224. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732903/