A scleral buckle is one of several ophthalmologic procedures that can be used to repair a retinal detachment. Retinal detachments are usually caused by retinal tears, and a scleral buckle can be used to close the retinal break. The use of scleral buckling will occasionally limit pupil dilation or constriction with no clinically significant pattern.
Scleral buckles come in many shapes and sizes. An encircling band is a thin silicone band sewn around the circumference of the sclera of the eye. Buckles are often placed under a band to create a dimple on the eye wall.
The scleral buckle is secured around the eyeball under the conjunctiva. This moves the wall of the eye closer to the detached retina. It also may move the retina closer to the vitreous. This alteration in the relationships of the tissues seems to allow the fluid which has formed under the retina to be pumped out, and the retina to re-attach. The physics or physiology of this process are not fully understood.
Retinal detachment surgery usually also involves the use of cryotherapy or laser photocoagulation. The laser or cryotherapy forms a permanent adhesion around the retinal break and prevents further accumulation of fluid and re-detachment. The usage of scleral buckle is a source of debate for retinal detachment surgery amongst surgeons, and research is being conducted to compare safety and effectiveness outcomes of pars plana vitrectomy with scleral buckle versus pars plana victrectomy without scleral buckle.
Scleral buckles are done using local or general anesthesia and are often done as outpatient procedures. In the majority of treatments the buckle is left in place permanently, although in some instances the buckles can be removed after the retina heals. The buckle may also be removed in the event of infection.
Results from two randomized controlled trials of 216 patients comparing retinal detachment outcomes from pneumatic retinopexy versus scleral buckle found some evidence suggesting that scleral buckle was less likely to result in a recurrence of retinal detachment than pneumatic retinopexy.
- Gutierrez M, Rodriguez JL, Zamora-De la Cruz D, Flores Pimentel MA, Jimenez-Corona A, Novak LC, Cano Hidalgo R, Graue F (2017). "Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear". Cochrane Database Syst Rev (4): CD012646. doi:10.1002/14651858.CD012646.
- Ebrahim, B; Frohman, L; Zarbin, M; Bhagat, N (2009). "Tonic Pupil Following Pars Plana Vitrectomy and Endolaser". Case Reports in Medicine. 2009: 970502. doi:10.1155/2009/970502. PMC . PMID 19721706.
- Hatef E, Sena DF, Fallano KA, Crews J, Do DV (2015). "Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments". 5: CD008350. doi:10.1002/14651858.CD008350.pub2. PMC . PMID 25950286.