Scleral buckling is a surgical procedure used in repairing retinal detachments. Scleral buckling can be done in an operating room under general anaesthesia or as an outpatient procedure if the retinal detachment is uncomplicated. During sclera buckling, the sclera--the white--of the eye is buckled over the repaired area to help the retina heal and reattach. While most sclera buckling is left in, temporary scleral buckling elements can be put in and then removed later if there is a problem with the eye after the retinal reattachment surgery.
Scleral Buckling Removal
To understand scleral buckling removal, it is important to understand how scleral buckles are installed in the eye during the retinal reattachment process.
After the eye is numbed, the eye is cut to expose the sclera. If the surgeon's view of the retinal detachment is blocked, he may perform a vitrectomy--removing of the vitreous, which is replaced with saline.
Once the surgeon can see the retina, they will perform one of two procedures. One procedure, called a laser photocoagulation is done if the retinal detachment is small. A laser light is shined through a contact lens to burn the area around the retinal tear. The resulting scar tissue seals the hole and prevents leakage. No incision is needed.
The second procedure, called a cryopexy, is done by using a freezing probe to freeze the outer surface of the eye over the detachment or tear. The freezing creates scar tissue that seals the hole and prevents leakage.
After a laser photocoagulation or cryopexy is performed, the surgeon indents the affected area of the sclera with silicone. The silicone comes in the form of a buckle or sponge, which closes the tear and reduces the eyeball's surface. This allows the eye to heal and prevents further separation of the vitreous.
In most cases, scleral buckling is left in for the lifetime of the patient, however, temporary scleral buckling elements can be put in and then removed later if the detachment is not severe. If a problem occurs with the eye after the retinal reattachment surgery and the scleral buckle needs to be removed, the surgeon may then enter the eye as he would during the retinal reattachment surgery and remove the buckle.
Healing time varies from person to person, but it is not uncommon for patients to be blind in the affected eye for extended periods of time after a scleral buckle is installed or removed.
Scleral Buckle Removal Dangers
In a study of 53 retinal detachment patients done by Peggy S. Lindsey, M.D., L Harrell Price, M.D. and Robert B. Welch, M.D., retinal redetachment occurred in 34 per cent of patients after scleral buckle elements were removed. Phthisis (infection) occurred in just two of the 53 patients and was caused by unexplained chronic intraocular inflammation in one patient and perforation of the eye--during the surgery--in the other patient.
As with any type of retinal reattachment surgery, there can also be complications such as bleeding under the retina, glaucoma, double vision, vitreous hemorrhaging, change in eyeglass prescription and cataracts. In extreme cases, it may be possible to lose the eye.