Scleral buckling is a surgical procedure used to treat rhegmatogenous retinal detachments (RRDs) by indenting the sclera to relieve vitreoretinal traction and support retinal reattachment.
Indications
Indications
Primary treatment for RRD, especially in cases with:
Single or multiple retinal breaks
Inferior detachments
Young phakic patients (better long-term outcomes than vitrectomy)
Lattice degeneration with breaks
Can be combined with pars plana vitrectomy (PPV) in complex cases.
Contraindications
Severe proliferative vitreoretinopathy (PVR)
Giant retinal tears
Advanced posterior segment pathology (e.g., severe diabetic retinopathy)
RRDs requiring extensive internal tamponade
Procedure Steps
Anesthesia: Local or general.
Localizing the Retinal Break: Indirect ophthalmoscopy or wide-field imaging.
Cryotherapy or Laser Photocoagulation: Applied around the break to create an adhesive scar.
Buckling Material Placement:
Encircling band (360°) for multiple breaks or extensive detachment.
Segmental buckle (silicone sponge or solid silicone) for localized detachment.
Sutured onto the sclera to indent (buckle) the eye wall, reducing traction.
Drainage of Subretinal Fluid (optional): Helps reattach the retina.
Postoperative Monitoring: Ensuring proper reattachment and preventing complications.
Postoperative Considerations
The procedure is typically performed under local anesthesia with sedation, though general anesthesia may be used in complex cases.
Visual Recovery: Gradual over weeks to months.
Complications:
Myopic shift (axial elongation)
Buckle infection or extrusion
Subretinal hemorrhage
Persistent or recurrent detachment
Success Rate: ~85–90% with a single procedure; may require PPV in complex cases.
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