The retina is the small layer of tissue in the back of the eye that filters light. It uses the optic nerve to send visual images and information to the brain.

The retina can be torn or completely detached. This often requires surgical treatment to prevent permanent vision loss.

A scleral buckle surgery attaches a small synthetic band on the white part of the eye, called the sclera, to change the shape of the eye. This helps to push the retina back in place to heal the tear or detachment.

Scleral buckle surgeries have a success rate that is over 90 percent. They can greatly help to improve vision and repair a torn or detached retina. There are some risks associated with the surgery, and additional surgeries are sometimes needed to correct vision.

Scleral buckle surgery is often covered, at least partially, by insurance since it is usually deemed a medically necessary procedure. It is performed at the hospital under anesthesia and costs several thousand dollars total.

You will usually need at least several days to recover after a scleral buckle surgery. You will likely need to wear an eye patch and limit activity.

Overall, a scleral buckle surgery can help to repair a torn or detached retina. It can save you from further damage to your vision.

When Scleral Buckle Surgery Is Needed

Scleral Buckle surgery has been used for decades to repair a retinal detachment. While retinal detachment happens spontaneously in most cases, it is sometimes caused by eye traumas.

It can be torn or ev...

It can be torn or even completely detached from the back wall of the eye. This can cause permanent vision loss if not treated quickly.

That said, the three main types and causes of retinal detachment that necessitate Scleral Buckle surgery include:

  1. Rhegmatogenous retinal detachment. Patients with this condition have a hole or tear in the retina. This allows fluids from the eye to enter the retina, separating and ultimately causing detachment of the retina from the retinal pigment epithelium. This membrane nourishes and provides oxygen to your retina.
  2. Tractional retinal detachment. This occurs if scar tissues on the surface of the retina contract, pulling the retina away from the back of the eye. This type rarely occurs and primarily affects patients with diabetes mellitus.
  3. Exudative detachment. This type of retinal detachment has no tears or breaks in the retina. However, they occur due to inflammatory disorders, cancer, Coat’s disease, or any other condition that causes fluid accumulation behind the retina.

Patients with retinal detachment often don’t complain about pain but may experience some symptoms. Primary symptoms include:

  • Partial loss of vision
  • Blurred vision
  • Sudden light flashes that appear when looking to the side
  • Sudden floaters in the field of vision, which can impair vision

Retinal detachment can occur in patients with the following risks:

  • Trauma to the eye
  • Advanced age, 50 years and above
  • Diabetes mellitus patients
  • Cataract removal surgery complications
  • Family history of retinal detachment
  • Extreme myopia, causing a lot of strain on the eye
  • Posterior vitreous detachment, especially in old adults

The Ins & Outs of Scleral Buckle Surgery

Scleral buckle surgery is a common method for treating retinal detachments and sometimes tears as well. The surgery is most commonly performed under general or local anesthesia at a hospital by a specialty trained surgeon.

During the surgery, the retina is pushed back into place. A small flexible band or sponge, usually made out of silicone or another synthetic material, is attached to the white part of the eye (the sclera). This band alters the shape of the eye and slightly pushes the eyeball down into the retina, allowing it to reattach and fixing any breaks.

The scleral buckle slightly changes the circumference of the eye. The band is usually permanently attached and covered by the skin of the eye so it is not visible.

Cryopexy or laser photocoagulation may also be performed at the time of a scleral buckling procedure in order to prevent possible repeat tears. Cryopexy involves freezing the outer surface of the eye, while laser photocoagulation burns it. Both are meant to create scar tissue that help to seal possible retinal breaks and tears.

Fluid buildup behind the retina may also be removed during surgery.

The main goal of treatment for retinal detachment is to seal tears or breaks and reattach the retina to the back wall of the eye. Scleral buckle surgery is often a good procedure for this.

young woman staring at the sun

Pros & Cons of Scleral Buckle Surgery

Most of the time, a scleral buckle surgery is considered to be successful in reattaching the retina and sealing up tears. If tears to the retina are minor, other less invasive procedures or even a temporary placement of a buckle may work.

A scleral buckle procedure is likely to cost around $3,000 to $5,000 total, which includes surgical fees, anesthesia costs, and hospital charges. Generally, the cost of this surgery is at least partially covered by health insurance, as retinal detachment is a medical emergency.

Several studies have shown scleral buckle surgeries to be successful in repairing detached retinas close to 90 percent of the time with the first surgery. In some cases, a second surgery will be needed.

Still, a scleral buckle procedure is a surgery. Therefore, the following are some risk factors associated with it:

  • Bleeding
  • Double vision
  • Scarring of the retina
  • Infection
  • Increased eye pressure
  • Vision loss

Discuss all of the potential complications, as well as benefits, of a scleral buckle procedure with your doctor beforehand.

Preparing for Your Surgery

When getting ready for scleral buckle surgery, your surgeon will likely run a range of tests and do a thorough exam, which may include a physical, to ensure that you are ready and healthy enough for surgery. Talk to your insurance provider to determine the level of coverage for the procedure and if you need prior authorization beforehand.

You will likely be told not to eat or drink anything except water for up to 24 hours before your surgery. The procedure itself will take about an hour or two, but you are usually unable to drive for at least a day due to the anesthesia. Be sure to arrange for someone to take you home as scleral buckle surgery is usually a same-day procedure.

Scleral Buckle Recovery

woman wearing eyepatch

After the surgical procedure, the doctor will place an eye patch over your eye to protect it for at least a day or two. You will likely meet with your surgeon or someone on the medical team within the first day or so after surgery for a follow-up visit.

Limit lifting and other strenuous activities for a few days after surgery. Your doctor will let you know exactly when you can return to normal activity.

You will be sore and likely have redness and swelling on and around the eye for the first several days after surgery. You will be given antibiotic eye drops that you will need to apply for several weeks to help with healing.

You may want to take medications for the pain. For the first three days after surgery, applying an ice pack every few hours for 15 to 20 minutes at a time can reduce swelling and discomfort.

You may be able to go back to work about two weeks after the surgery, depending on the type of job you have. You usually need to wait about a month or two to resume heavy lifting and exercise. You also should limit rapid eye movement and reading for the first few weeks after surgery.

If you experience increasing pain and swelling, discharge from the eye, or decreased vision, let your doctor know right away.

Alternatives to Scleral Buckle Surgery

Your eye surgeon will prescribe the best procedure for retinal detachment that suits your condition. If a Scleral Buckle procedure isn’t viable, your doctor may alert you to a couple of alternatives. The first is a vitrectomy, and the second is pneumatic retinopexy.

It’s also possible you will want to consider either of these procedures given the cost of a Scleral Buckle surgery. The estimated price of Scleral Buckle surgery is between $3,000 and $5,000 all-in. That includes costs for the surgeon and anesthesiologist and for the surgery center or hospital. Final patient costs depend on a person’s insurance coverage, deductibles and out-of-pocket maximums. Medicare provides coverage for this surgery but not at 100%.

Vitrectomy

Vitrectomy is an alternative surgery used to treat retina and vitreous eye problems. During the procedure, your eye surgeon removes and replaces the vitreous with another solution. Any tears or holes in the retina are also repaired during the surgery. Unlike Scleral Buckle, this is a better-controlled procedure, especially due to advanced equipment.

Pneumatic Retinopexy

Pneumatic Retinopexy is an outpatient procedure used to repair some types of retinal detachments. During the procedure, the eye is injected with a gas bubble to gently push the retina into position. The procedure is done alongside photocoagulation or freezing therapy to seal the area around it. This alternative is preferred as it is safer and has better efficacy.

References

Scleral Buckle Surgery for Primary Retinal Detachment Without Posterior Vitreous Detachment. (November 2016). Retina.

Facts About Retinal Detachment. (October 2009). National Eye Institute (NEI).

Scleral Buckle. (2019). Mayo Clinic.

Scleral Buckle for Rhegmatogenous Retinal Detachment. (October 2015). American Academy of Ophthalmology (AAO).

Retinal Detachment. (2019). The American Society of Retina Specialists.

Cost Comparison of Scleral Buckle Versus Vitrectomy for Rhegmatogenous Retinal Detachment Repair. (September 2018). American Journal of Ophthalmology.

Retinal Detachment. (March 2019). Mayo Clinic.

A Review of Retinal Detachment Repair. (January 2019). Review of Ophthalmology.

Anatomic Success of Scleral Buckling for Rhegmatogenous Retinal Detachment- a Retrospective Study of 524 Cases. (March 2010). Ophthalmologica.

Cataract surgery. (August 31, 2019). Mayo Clinic.

Vitrectomy for retinal detachment. (December 23, 2020). National Eye Institute.

Comparison between pneumatic retinopexy and Scleral Buckle for retinal detachment repair. (November 1, 2017). Ophthalmic Surgery, Lasers and Imaging Retinal.

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