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What to Know About Scleral Buckling

Medically Reviewed by Dan Brennan, MD on June 05, 2021

‌Scleral buckling, also known as belt buckling, is a type of surgery used to repair retinal detachment and bring your eyesight back. Retinal detachment happens when the retina, a thin layer of cells seen at the back of the eye, pulls away from its normal position.‌

The sclera is the visible white part of your eye. It functions like an outer wall that protects the delicate inside parts of your eye. In scleral buckling or belt buckling, the surgeon first opens the eye and seals the retina back together. The surgeon then stitches material like a sponge, rubber, or plastic to the sclera so that the retina stays in place. The scleral buckle is placed in the eye permanently. ‌

The scleral buckling surgery usually takes 45 to 60 minutes and the patient can go home the same day.

When Do You Need Scleral Buckling?

‌A scleral buckling procedure is used to treat the following medical conditions:

  • ‌Rhegmatogenous retinal detachment. A rhegmatogenous retinal detachment takes place when there’s a hole or tear in the retina which causes fluid to pass through and collect under the retina. This makes the retina move away from the tissues under it. You can lose your eyesight because of it. 
  • Attached posterior hyaloid. Mostly found in young patients, an attached posterior hyaloid is a membrane that separates the back of the vitreous humour from the retina.
  • ‌Detachments due to dialysis. Caused by treatment for kidney failure, these detachments occur without a retinal tear.
  • Complex retinal detachments. These detachments involve multiple tears.

Certain factors can increase the need for scleral buckling surgery, including:

  • Myopia (nearsightedness)
  • ‌Other eye disorders, like uveitis (a type of eye inflammation)
  • ‌Diabetes
  • ‌A family history of retinal detachment
  • ‌‌Eye surgeries carried out previously such as a cataract surgery 
  • ‌A previous eye injury or retinal detachment in one eye
  • Aging, with retinal detachment being more common in those age 50 and older

‌A retinal detachment may happen naturally on its own but sometimes it can happen because of an injury.

When You Should Seek Medical Help

‌Retinal detachment can be painless but it's still considered a medical emergency because it can cause you to lose your eyesight permanently.  Some typical symptoms of retinal detachment to watch out for include:

  • ‌Sudden appearance of specks called ‘floaters’ that hover through your field of vision. Having several of them can stop you from seeing well.
  • Photopsia, or flashes of light in one or both eyes.
  • Blurred vision.
  • ‌Slowly reducing peripheral (side) vision.
  • ‌Seeing a curtain-like shadow over your visual field.

Get emergency help when you start to experience any of the above symptoms. 

Preparing for Scleral Buckling Surgery

‌Your doctor will give you specific instructions on how to prepare for your surgery. You may be asked not to eat anything after midnight the day before the procedure. You may also be asked to stop taking certain medication temporarily.  

Post-Surgery Care

‌The patient will be given antibiotics and painkillers, and sometimes antibiotic eyedrops. The patient may experience pain, redness, and swelling but these will usually resolve within two weeks. Ice packs can be used to reduce pain and swelling.

The patient may need to take several precautions, including:

  • Wearing protective eyewear. The patient may need to wear an eye patch for a few days and sunglasses during the daytime. The patient also has to ensure the eyes are covered when bathing or showering to prevent soap and shampoo from entering the eyes. 
  • Avoiding work, travel, sports, and other activities. The patient may need to avoid sports, activities, driving, going back to work, and excessive screen time on TVs, laptops, and smartphones. Travel and high-altitude trekking should be avoided as these can cause the pressure in the eye to increase.

‌You may be asked to follow up with your surgeon to monitor how well you’re healing. Inform your surgeon immediately if, after the surgery, your vision starts to reduce, your pain increases, or swelling starts to form around the eye.

Outlook

‌The results of your belt buckling surgery can depend on many different factors like how good or bad your vision was before the retinal detachment, how bad the detachment is, and other complications. Discuss the potential outcome with your surgeon so you know what to expect. ‌

The results of scleral buckling surgery for retinal detachment are generally very good.  The procedure is successful nine times out of 10. Sometimes, the patient may need more than one surgery to place the retina correctly in its original position.  

Show Sources

SOURCES:

Cleveland Clinic: "Retinal Detachment." 

John Hopkins Medicine: "Scleral Buckling." 

Mayo Clinic: "A look inside your eyes," "Retinal detachment." 

MedicineNet:  "How long does a scleral buckle last?," "Medical Definition of Scleral Buckle." 

Medscape: "Scleral Buckle." 

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