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.
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
- 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.
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Dear Laila,
I am sorry.
Distortion following a macular detachment is not uncommon, but it may be too early to “give up.”
I’d ask your doctor for an explanation as there can be so many causes of distortion at this point following an operation.
Randy
Hi Doctor Wong,
My name is John, I am 29 years old and from Melbourne Australia and can I just start off from saying what a great opportunity this website provides for indivduals such as myself to gain some guidance and clarification on what they are going through. I am impressed with your commitment to helping people via this website. Well done!
My particular issue is that I have had a scleral buckle put in place for a peripheral retinal detachment (macula on) for my right eye. My retina was peeling away from the outer peripheral so I was slowly losing my vision from my nasal peripheral side. I am shortsighted and before the operation was at -4.25 for both eyes.
I had the operation on Monday 22nd of October (4, nearly 5 weeks ago) and my vision is still blurry. It is very hard to read out of that eye and letters appear wavy and distorted. I was wondering if this is normal and how long should I wait before being worried?
I also find it hard to focus on things (some days are better than others) and this sometimes causes my eye to water. I also suffer sudden shots of pain randomly from the eye and cannot move my head around to focus on different objects too quickly, for eg. a person entering the room. Sometimes if I move my eye inwards towards my nasal side to look to my left without moving my head I can feel a foreign object in the eye that does not necessarily hurt but does feel uncomfortable. Is this normal or will I potentially have to have the buckle removed?
Thanks again for this opportunity and sorry for the long comment.
John.
Dear John,
The focusing issue may indeed be need for glasses or contacts. It is possible, too, that you’ve developed a cataract which may also cause distortion, cause strain and blurry vision.
The foreign sensation may indeed be the buckle, but it takes months to heal from these things and I don’t necessarily think you’ll need it removed…too early to tell.
Thanks for the comments.
r
I have had 5 retinal detachment repair surgeries, the last one was scleral buckle with vitrectomy plus removal of the lens. My eye is filled with oil. I have been fairly miserable since the Dec. 29th 2012 surgery. My eye pressure has been high, running in high 30s to low 40s. We are trying various drop combinations to no avail. I have frequent pain, not crushing, but not fun either. Every day in the evening especially I have watering of the eye and pain for hours. I seem to have come down with a head cold virus that will not go away, and the left sinus where the surgery is near is the one that drains the worst. I can hardly keep the surgical eye open at times, I feel there is a force trying to shut it closed, kind of like staring into bright light. None of my previous surgeries have had post-surgery complications like this. I am getting care from a retinal surgeon, but just wonder if any other theories, ideas may be out there? The surgeon said he may have to go back into the eye and drain out some of the oil. Thanks so much for any information that may give me hope.
Don,
I can’t accurately assess your situation without an exam.
My thoughts;
1. Symptoms due to increased pressure
2. Allergy to some of the drops?
r
Dr Wong
I have scleral Buckle insert my right eye my sergant says i had develop a early stage cataract. she is rectinal specialist not a cataract specialist i need to go back my eye doctor.
my eye been red more than 2 months . i used the special eye drop for anti infected , it did not help i went to buy allergy eye drop over walmart. it help less than 30 minute. but on the label said i cannot use more than so many days.during 2 eye specialist with 2 different
doctor. they never mention my red eyes.yes they can see but they never said a word and i forgot to ask.i have many physical issue my health insurance only pay so much. each time
i went to see doctor i have to pay copay and a different of health treatment deductible.just have no extra money to pay.what can possible be about 1 of my operated eye alway bloody red . please what might be happen .so i be more aware. and look for right doctor for my issue
thanks
Dr. Wong,
Thanks for your reply. Since writing to you, my retina surgeon removed some of the oil from my eye to relieve pressure. For 3 weeks I was doing great, then yesterday, February 25th, my eye pressure sky-rocketed to 46! My symptoms are exactly as before, very sensitive to light, constant ache accompanied by sharp prickly sensations,and the left sinus runs quite a bit. This in not an allergy to drops, I was not on pressure drops when this happened. Also, I never had any reactions to the post-surgery drops either. Yesterday my doctor looked for unusual things, like enlarged blood vessels, collapsing eye walls, blocked eye drain or blocked sinus. He could find nothing wrong. He has put me back on Combigan and I have been on Lotemax since partial removal of the oil. I fear that a deeper problem remains, my belief is that removal of a little oil only masked the real problem. If you have any ideas from your experiences, I would be most appreciative. This is a wonderful service you provide, thanks for that!
Don C.
Mikki,
It’s impossible for me to know why the eye is red. I can’t examine you. Stick with your doctors’ advice.
Randy
Dear Don,
I’d be speculating given the inability to examine you.
I wish you the best. So sorry I can’t even make and educated guess.
Randy
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
http://www.TotalRetina.com
http://www.RetinaEyeDoctor.com
Hi Dr Wong,
I was losing my sight in my right eye and was diagnosed with retinal detachment. On Jan 4th 2013 the surgeon inserted a scleral buckle and did a vitrectomy with a gas bubble. I can see, however my sight is much worse than before. During my last visit the Dr told me that it looked as though I have scarring, which could be corrected with another surgery and that I might develop cataracts in the eye. Is there anything that I can do to avoid this?
I also notice that if I lean over for too long I feel a pressure in the eye, should I be concerned?
Thanks,
Martha
Martha,
Scarring means several things to me, not sure what your doctor may have meant. In my opinion, cataracts are often to be expected following retinal detachment surgery. Remember, too, cataracts form in everyone!
No telling about the pressure feeling….sinuses?
Randy
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
http://www.TotalRetina.com
http://www.RetinaEyeDoctor.com
Dear Dr. Wong,
Thank you for your informative website. It’s very helpful to patients and families. We are from Atlanta, GA. My 13-year old daughter was just diagnosed with retinal detachment on her left eye this week and a surgery has been scheduled for the coming Thursday. My daughter complained about fuzziness in her left eye in November 2012 and our regular OD didn’t know what the problem was after two visits (in December and February). Then on March 15th, we decided to see another OD who found the RD problem right away because she herself had suffered from RD two years ago. She recommended a retina specialist in our area who has recommended the procedure of scleral buckle plus vitrectomy with gas bubble. Because we didn’t find the RD sooner and our 13-year old’s brain has adapted so quickly to using her right eye only, both the OD and the retina specialist say that our daughter’s macula is currently partially detached, which presents another level of difficulty to gaining vision back.
We have read up a lot on RD, its treatment and recovery prospect. We have some questions.
1. In your experience, what is the chance of getting some vision back (say 20/80 with glasses on the left eye) assuming the retinal reattachment surgery is successful? Her right eye sees 20/20 with contact lens.
2. Scleral buckling has side effects, one of which is increased myopia. Another one is a smaller looking eye size with buckling. What are potential side effects if we were to remove the buckle a few months after retina is reattached? Wouldn’t it be better to remove the buckle after it has done its job?
3. We still don’t know how our 13-year daughter could have suffered from RD. There is not a family history nor any remote chance of trauma. The retinal specialist believes it has to be sport injury a year ago. Our daughter is a soccer player for her middle school and in one game about 7 or 8 months ago, the soccer ball hit her face causing her mouth to bleed due to dental braces. We don’t think a big size 5 soccer ball could have hit the eye the way a tennis ball or softball would. On the other hand, our OD thinks it might be the CRT lenses (hard contact lenses worn at night to correct vision but don’t wear during the day) that have done some effect to the eye ball over the years which ultimately might have caused RD. In Atlanta there is an OD who is a big proponent of CRT lenses for kids because he says it deters myopia and prevents retinal disease (ironically it doesn’t do so for us). Our daughter started CRT lenses since 3rd grade. The lenses aren’t uncomfortable for her and actually worked very well until last November when she started complaining about the vision fuzziness. We just don’t know. Have you encountered any instance of RD with young patients who use CRT lenses?
Thank you so much for your help.
I had the buckle procedure only two days ago and understand that my vision will take some time to recover. I wish I had a better idea of what to expect regarding my recovery. I still have the pre-surgery loss of a field of vision due to retinal detachment and the remaining vision is so blurry as to be basically useless. I have been told I can return to work in 3 days so am hopeful that with a decrease in the swelling there will be dramatic improvement, however I am worried this is not realistic, especially after reading some of the prior posts on this site. Would you share a “typical” recovery after the scleral buckle procedure?
Allen Y,
1. I have no idea what vision she has now. Can’t even guess how much she’ll improve. The variables influencing eventual vision; degree and time which macula is detached. On the other hand, I’ve seen anything happen with kids.
2. If the buckle is done too tightly or too “high” these might be issues. Removing the buckle after 6 weeks is possible, but removing the buckle probably won’t reduce the myopia….there will be scar tissue on the OUTSIDE of the eye preventing the eye from regaining its original shape. Try not to play doctor too much. The whole key is to get the retina attached….that’s the primary goal.
3. Have no idea about the trauma. Usually there is a history of being knocked out our concussion (ie. pretty severe trauma). RD happens in myopia more often. CRT is used to fix myopia. No known causal effect between CRT and RD. Makes no sense.
Randy
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
http://www.TotalRetina.com
http://www.RetinaEyeDoctor.com
Dear Dana,
Every case is different. 3 days sounds wonderful, but there is no typical healing time.
Sorry I’m so useless.
Randy
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
http://www.TotalRetina.com
http://www.RetinaEyeDoctor.com
Hi. Dr. Wong. I had an RD and scleral buckle 9 weeks ago and still have trouble seeing. I am a 55 year old male, otherwise in good health. My eyes have been nearsighted since I was a child, the left one worse than the right; all of which was corrected to 20/20 with glasses. Here is the history of the RD on my left eye (called here LE). In late November 2012, I noticed some strange light sensations in the corner of my LE. I didn’t think much of them — though for your readers, in retrospect I should have gone right to the doctor. In December there were some odd floaters. In very early January there was a liquid curtain in the lower right of my LE (that’s where it appeared to me through my eye). So I went to the doctor 3 days later and 2 days after that he did a pneumatic retinopexy with cropexy on January 8, 2013. I had to keep my head tilted 2 weeks. It seemed to be working, I recovered to 20/70, but then a liquid curtain appeared in the upper right of the LE. So he said that was another peripheral tear, and this time, given the location in the lower part of the eye he couldn’t do the retinopexy, but that it would require a scleral buckle and vitrectomy. So the latter was done by him on January 28, 2013. This time I had to keep my head down for 2 weeks. As of today, 9 weeks later, the gas bubble has dissipated (it took 8 weeks for this to happen). My eye is still a little red. The retina is fully reattached and holding. Here is the problem: I cannot see well out of the LE. Everything is blurred, and quite distorted like looking in a fun house mirror. For example, if I look at a picture frame instead of being rectangular, the sides are curved and wavy in or out, also irregularly. So today the surgeon had an OCT done of my retina and he said that the macula did not appear to have a physical problem such as scarring. The macula was similar on LE to right eye. Then, I went to an optometrist this afternoon and I could not even see the large E on the chart through my LE with my glasses. And then he tried different lenses and solutions (including things for astigmatism) and nothing worked for my LE to see even the largest E. Instead the white projection around the E looked like a flag occasionally waving. So I am legally blind in my LE and lenses won’t help — at least not today. My question why is this happening and what can be done? Am I at a dead end? Or might the LE improve just with healing over the next months? If so, will that only be minor, or could it improve in a major way? Right now my understanding is that I am stuck with a legally blind LE and that if it gets better over time it will only be by a minor amount (maybe 20/200 and still wavy), and that nothing else can be done since there is no evidence of physical scarring to the macula that would merit further surgery. Any thoughts? My doctor only seems to tell me things very little by little. I didn’t realize the retina could be fully re-attached (as here) but so hopelessly wrecked as to be largely useless except to see blurrily. Luckily I see 20/20 with my right eye, but if that one fails, I will be in big trouble seeing.
Dr. Wong,
Do you do the Scleral Buckle operation?
Hi doctor Wong,
I am Abrar, from Pakistan. My brother is having retinal detachment before 16 years. We were totaly fall on internet to find the recovery of this infection but Alas we were failed to find it and now this infection has been recover so I want to ask about this that there is any hospital or doctor which can treat this in any country ? please reply me fast! I wanna also ask somthing about this diseases !!
Regards!
Dear Bob in Pittsburgh, PA,
Yes. Quite a few. We’ve a video on YouTube if interested.
http://www.youtube.com/watch?v=CJy8qjNojAc
Thanks for the inquiry.
r
Dear Dr Wong
My buckle has come off after two years. The doctor said that they don’t usually do anything unless it protrudes or there is an infection. However , I can feel the buckle on the inner underside of my eye and I have a small cyst there too. I have had five ops to remedy a re-detaching retina in right eye so I understand that it is best not to operate unnecessarily to avoid further stress to this eye.
History: two gas bubble vitrectomy ops; two oil vitrectomy ops; a buckle during one vitrectomy; a peeling of retina scar tissue around peripheral and new lens during another; fifth op was just to remove oil. Retina is now flat. Vision not very good. There is still traction, macular scarring and some oil bubbles floating around. Now the buckle has come off!
I know it’s unusual for buckle to come off, but is it harmful to eye?
Thank you for your time. Bless
Hi Dr. Wong,
Thanks in advance for your time. I had scleral buckle surgery 5 days ago for a left eye retinal detachment, macula-on. The whole thing has been a terrifying nightmare to me,to say the least. I’m a 38 year old female with 3 young toddlers to care for. My two questions are:
1. My doc (who had been wonderful) lifted all restrictions on me 3 days post surgery after two post op exams when he observed reattachment, no fluid. Is this too soon? I am being very cautious including wearing safety goggles around my energetic little ones.
2. I asked what the “failure window” is for scleral buckle surgery, meaning if it is going to fail is it known in a week, a month, 6 months….. My doc answered this 3 days post op with “it’s over. It will not fail. It was a success.” While that gave me enormous relief, can this be known so absolutely so soon?
Thank you for this service.
I meant to say my doc “has” been wonderful, not “had.”
Dear Peter B,
Wondering if you’ve developed a cataract?
A cataract might decrease your vision, especially with two procedures utilizing gas.
(For subsequent readers, the length of head positioning is determined, in part, by the type of gas used. I prefer a gas that is absorbed quickly and thus usually request my patients maintain head positioning for about 5 days at most.)
The misleading thing about retinal detachments…”success” refers to anatomic success and not necessarily vision.
Let us know.
Randy
AbRaR,
Please ask your question again, I don’t understand your question.
Randy
Dear Frida,
A scleral buckle can usually be removed…safely after the initial 6 weeks or so. I agree that it is usually unnecessary to be removed unless there is infection or erosion through the conjunctiva.
It is usually not harmful to remove a buckle.
Randy
Dear CSS,
1. If you are attached and no gas, lifting restrictions is probably fine (I can’t really say because I don’t actually know the condition of your eye, but I generally would agree). No worry about the goggles, won’t really do anything. You’ll redetach with or without goggles. Imagine if every parent were to sustain a retinal detachment every time they were hit by a child (I’d be retired!).
2. I would say that if there are no issues at 6 weeks, you are probably out of the “failure window.”
r
You mention crt for myopia what is that. Do you mean it can improve distance vision after a sclera buckle.
If not is there something else I can have done as I am very short sighted.
Thanks for all your help with this site. It is invaluable for many people
Donna,
Could you rephrase your question….”crt”? Where did I mention that?
r
Hello Dr. Wong. I am so happy to have discovered your wonderful forum. I had a scleral buckling done in 1972 at the age of 25. Since then I have had 2 brain MRI’s and around 5 lumbar ones done in the last 4 years. I have mild MS and my neurologist wants me to have a brain and full spine MRI. The MRI center she sent me to is refusing to perform it because they say I have metal in my eye and it could be very dangerous. I was of the understanding that a non-ferrous metal was used if at all. Since I have had so many without problems do you think it is possible that a ferrous metal was used and wouldn’t I have had a problem by now after so many being done? My current Ophthalmologist feels there is no metal in the buckle. Am I taking a chance? I called the hospital where I had it done and they destroyed the records years ago and the Dr. who performed the surgery has been dead for 10 years. What would happen after so many years if in fact a ferrous metal was used?
thank you, Susan Mcshane
Dear Susan,
1. If there were metal used, I agree, non-ferrous. For a while, “metal” clips were used by some surgeons to join the ends of the buckle. I never used them, so don’t really know that much about them, but your doctor’s concern is common.
2. My suggestion would be to get a simple xray of your head. This should help quite a bit.
Randy
Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia
http://www.RetinaEyeDoctor.com