Why is Scleral Buckle needed?

Retinal  detachment occurs when there is  a tear / hole  in the retina through which the liquified vitreous gel seeps through ,cleaving the retina form the underlying layers/ coats of the eyeball. The retain can surgically be opposed to these layers by two procedures . Scleral buckle where the outer layers and brought towards the retina or vitrectomy wherein the retina is brought towards the outer layers .  Untreated, a retinal detachment can lead to permanent blindness.

Benefits of the Scleral Buckle treatment

• Scleral buckling is an extra ocular procedure
• It has a lesser risk of  cataract progression compared to vitrectomy 
• The postoperative visual recovery is faster 
• If required the buckle element can be repositioned if the primary surgery does not result in apposition 
• It is the preferred treatment choice in simple retinal detachments and in young people where vitrectomy is more difficult 

Preparation before the procedure

• A complete detailed evaluation of the retina will be done by the surgeon .
• The eye will be dilated
• Local anaesthetic is injected and in select cases a mild sedation
• General anaesthesia is preferred in small children 

Scleral Buckle treatment procedure

The conjunctiva (outer transparent covering of the eyeball )  is incised and the  causative tear/ hole in the retina is identified and marked. Cryotherapy is done over this area to cause  scarring and thereby promote  adhesion of the detached retina to the choroid.  A scleral band/tyre (scleral buckle element) is sutured on to the sclera in the area of the tear/ hole .As  the sutures are tightened the sclera folds inward and is brought closer to the retina .In some cases the  fluid between the retina and choroid may be drained   or gas/ air injected into the eyeball ensuring faster attachment.

Precautions and care after the procedure

• A bandage is applied in place for a minimum of 24 hrs 
• Post operatively pain/ discomfort ,  redness and swelling around the eye  is common and can be managed adequately with drops and analgesics
• Swimming / contact lens use and unclean water entering eye is to be avoided for a few weeks 
• You will be able to resume routine activities in a  weeks time
• There  may be some change in the glass prescriptions at the end of a 6 week period 

Result of Scleral Buckle treatment

• Most cases of simple retinal detachment have  a good structural  outcome  with scleral buckle surgery
• In cases  where  the  primary surgery fails, surgery  can be revised 
• In   cases where the retinal detachment progresses despite a scleral buckle surgery , vitrectomy can still be the  next option

Written by: Dr. Jyothsna Rajagopalan – Consultant Ophthalmologist, Coles Road