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.

A Scleral Buckle is Placed to Repair a Retinal Detachment

The Scleral Buckle Reduces the Diameter of the Eye (Yellow Arrows)

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

  1. The eye is not taken out.  We wouldn’t be able to put it back in.
  2. 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.
  3. 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.
  4. 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.

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  1. Alex,

    I would wait, but have frequent exams to monitor closely for any signs of enlarging retinal detachment or development of PVR. I generally am not too cautious, but if you are proven to be a patient prone to PVR, I, too might advise caution.

    Keep in touch.

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

  2. Dear Jeff,

    Honestly don’t know what to say given the information and the inability to examine your son. I agree, sounds very unusual. I’d seek a second opinion at the very least.

    Best of luck to your son.

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

  3. Scott Baker says:

    Dr. Wong,
    Thought I would let you know that I completed LenSx Cataract Surgery last week UVA is 20/20 left and 20/25 rt
    The rt eye has a slight after cataract so that may go to 20/20 after yag laser the rt eye was my eye that had a macula off rd 37 years ago so the results are amazing. I had the Alcon Toric IOLs implanted so for anyone worried about the long term results of Scleral Bucking Surgery I am proof that the Surgery works I had SB in both Eyes 37 years ago and now have near perfect vision after IOL implants. Thanks for your advice a few months ago. I also have been to a Retinal Specialist Post Op and she says everything is fine

  4. John D. Garrett says:

    My daughter recently had a scleral buckling. Following surgery, there is a notable diference in the shape and size of the eye. Also, she appears to have a lazy eye (if that makes any sence at all.) Being a young lady this difference has her and me (Dad) quiote concerned. Me, I would consider my precious dayghter beautiful if she had one eye in the middle of her head, but, she is devestated. Is this something that will be as it is forever or will it improve with time? My daughter has severe nearsightedness and the tear was to significat for laser treatment.
    Any information you could share would be most appreciated.

    Thanks so much….

  5. Dear Scott,

    Lucky you! Sounds like you are very, very lucky.

    Not all macula off detachments fare so well!

    Thanks for sharing,

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

  6. Dear Sir,
    I have my buckle surgery done and now it seems the buckle is being pushed out. The doctors have advised for an immediate removal. What are the side effects and risk factors? Also, is there any harm in removal. I had vitrectomy done after buckling.

  7. i too, had a scleral buckle implanted 30 years ago. it has not cause me any problems, the doctor that did it did advise me that if i saw floaters i needed to have it checked. i see floaters all the time, even right after the surgery took place, and have had it checked every couple years or so, and have had no problems with it at all.

  8. Dear Real S.,

    Longstanding floaters, especially after your being examined, don’t necessarily mean you have a retinal detachment. Perhaps you should been advised to have “new” floaters examined.

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

  9. Dr. Maria,

    If the buckle is eroding through the outside, causing redness and tearing. Removing it should be okay.

    Best to ask your doctor.

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

  10. Hello, doctor

    Why is that I suffer pressure on my skull after I fail my scleral buckling surgery 3 years ago , ie there has been extrusion as black lined shadow appear on my pupil ???

    and why that pressure kept on affecting my cortical region ,causing me cognitive problems???

    Even my local surgeon know nothing about the pressure???

    Pls advise me.Thanks

  11. mr albert,

    I’m not able to make any constructive comments as I am unable to examine you. It is unusual for you to have the symptoms of pressure in the eye with the scleral buckle. There should not be any cognitive problems.


  12. Jane Sarver says:

    My grandson had retinal detachment surgery and had a band placed around his eye last year at the age of 17, he has periodically been suffering eye pain in that eye, is there a reason we should be concerned?

  13. Jane,
    A scleral buckle usually does not cause pain. Bring to the attention of his doctor….sometimes eye pain is not actually from anything wrong with the eye, but sinus disease.


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