Scleral Buckle Surgery
Scleral buckling is an ophthalmic surgical technique that has been successfully employed as a primary or adjuvant procedure to repair rhegmatogenous retinal detachments
Indications:
Young patients
Phakic eyes
High myopia
Absence of a PVD
The absence of advanced proliferative vitreoretinopathy (PVR) changes. RRD with PVR grade C1 can be treated with SB
RRD secondary to breaks anterior to the equator
RRD secondary to retinal dialysis
Contraindications:
Scleromalacia or severe scleral thinning
Advanced PVR changes
Dense vitreous hemorrhage or significant cataract which precludes fundus view
Previous glaucoma surgery
RRD secondary a giant retinal tear
RRD secondary to retinal breaks posterior to the equator
The most important skill required in surgery for retinal detachment is the ability to detect all retinal breaks and additional areas of vitreoretinal pathology.
Scleral buckling is performed to produce functional closure of retinal breaks responsible for retinal detachment and to reduce the chances of recurrent detachment.
Various kinds and shapes of silicone rubber elements are used, including segments of silicone sponge as well as solid silicone shaped into bands for encircling the eye and into additional forms to augment the width and height of the buckle in selected areas.
The specific configuration of the scleral buckle depends upon a number of factors.
Following localization and treatment of retinal breaks and areas of vitreoretinal degeneration, the silicone buckling element is secured to the scleral surface, usually with sutures or scleral tunnels.
Drainage of subretinal fluid is often performed.
Intravitreal gas or air injection is sometimes employed in conjunction with scleral buckling.
Problems encountered at any point of the procedure may require modifications in technique, often leading to a vitrectomy surgery.
STEPS:
1) Anesthesia – Local (peribulbar/retrobulbar) or general anesthesia.
2) Conjunctival peritomy – Incision and reflection of conjunctiva around the limbus.
3) Rectus muscle isolation – Identify and loop the four rectus muscles.
4) Localization of retinal break – Indirect ophthalmoscopy to find the retinal tear.
5) Cryotherapy – Apply cryopexy over the retinal break to create chorioretinal adhesion.
6) Scleral buckle placement – Select and place the silicone band or sponge over the sclera.
7) Suture fixation – Secure buckle to sclera with non-absorbable sutures.
8) Adjust buckle height – Tighten to indent the sclera over the break.
9) Drain subretinal fluid (optional) – External drainage if retinal detachment is bullous.
10) Recheck retina – Confirm closure of break and retinal reattachment.
11) Conjunctival closure – Reposition and suture conjunctiva.
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Image from Rajan Eye Care Hospital
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