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What is a Scleral Buckle?

By H. Colledge
Updated Mar 03, 2024
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A scleral buckle is a type of surgical operation used in the treatment of a detached retina. The retina is the light-detecting layer inside the eyeball, and it can become separated from the tissues that nourish it in the rear wall of the eye. Unless urgent action is taken, the retinal cells can die off, causing blindness. The scleral buckle procedure involves attaching a piece of silicone to the outer layer of the eyeball in such a way that it pushes the wall of the eyeball inward. This means that the supportive tissues make contact with the retina once more.

Situated at the back of the eye, the retina consists of an inner layer that reacts to light, made up of special cells called rods and cones, and an outer layer known as the retinal pigment epithelium. The retinal pigment epithelium normally provides the rods and cones with nourishment, but when a retinal detachment occurs the two layers become separated. This often happens in association with a rip in the inner layer. Symptoms of retinal detachment include seeing flashing lights and specks floating in front of the eyes. A person's vision may slowly start to disappear, in a process sometimes experienced as a black veil descending over the eye.

In order to avoid permanent loss of vision, eye surgery is required. Scleral buckle surgery is an option which may be performed under a local or general anesthetic. The urgency with which the operation is carried out depends on whether the detachment has included the area of the retina responsible for focused, central vision, known as the macula. If the macula has not yet been detached, surgery is usually carried out immediately to preserve the sight. When the macula is already affected by the detachment, then it is often impossible for vision to be fully restored even with surgery, so the operation becomes less urgent.

Scleral buckling involves sewing a tiny piece of solid silicone, or silicone sponge, to the outer white coat, or sclera, of the eye. Sometimes a silicone stump is attached to push the eyeball inward at a certain point, and in other cases a longer strip is sewn all the way round to act like a belt and draw the wall of the eyeball in. Both methods aim to bring the retinal pigment epithelium back into contact with the detached inner layer of the retina. In addition to carrying out a scleral buckle procedure, any holes in the retina may be fixed by freezing or the use of lasers.

After the scleral buckle is in place, any fluid that may have collected behind the detached retina may be drained. Some surgeons prefer not to do this as possible complications of drainage include hemorrhage and perforation of the retina, while others think that drainage has the benefit of decreasing the pressure in the eye, helping the two layers of the retina remain together and encouraging healing. If drainage is not carried out, the body eventually absorbs the fluid naturally.

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