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Scleral Buckling Surgery for Retinal Detachment
Understanding Scleral Buckling
Scleral buckling is a surgical technique that repairs a detached retina from the outside of the eye. It has been used successfully for decades and remains a preferred approach for many types of retinal detachment, particularly in younger patients with specific detachment patterns.
Unlike vitrectomy, a surgery performed inside the eye that involves removing the vitreous gel, scleral buckling works entirely from the outside. A retina specialist stitches a small silicone element directly onto the sclera, the firm white outer wall of the eye. This creates a gentle inward indentation that brings the eye wall closer to the detached retina, encouraging the two layers to come back into contact.
The procedure is most commonly used for rhegmatogenous (reg-ma-TODGE-en-us) retinal detachment, the most frequent type. This occurs when a tear or hole in the retina allows fluid to seep underneath and separate the retina from the retinal pigment epithelium, the supportive cell layer directly behind it.
When the retina tears, fluid from the vitreous can pass through the break and accumulate beneath the retina. The scleral buckle addresses this by pushing the eye wall inward toward the tear, closing the break from the outside and preventing additional fluid from flowing through.
Once the tear is sealed, a natural pumping mechanism within the retinal pigment epithelium gradually absorbs the trapped fluid. As this fluid clears, the retina flattens back against the eye wall and reattaches. To ensure a permanent seal, cryotherapy (a controlled freezing treatment) or laser is applied around the retinal break, creating a lasting bond between the retina and the tissue beneath it.
The choice of buckle element depends on the number of retinal breaks, their locations, and the overall extent of the detachment. The two primary options are segmental buckles and encircling bands.
- A segmental buckle is a small silicone sponge placed directly over the retinal break. It is used when the detachment is limited to a single area of the retina.
- An encircling band is a thin silicone strip that wraps all the way around the circumference of the eye. It is used for larger detachments, multiple breaks in different locations, or when broader support for the retina is needed.
In some cases, a retina specialist may use both a segmental element and an encircling band together for additional stability and more comprehensive coverage.
Vitrectomy has become more widely used for retinal detachment repair in recent years, but scleral buckling remains the preferred approach in specific situations. For younger patients who still have their natural lens in place (called phakic patients) with a relatively simple detachment and a limited number of tears, scleral buckling offers meaningful advantages.
Because scleral buckling does not involve entering the eye or removing the vitreous, it avoids disturbing the natural internal structure of the eye. Research suggests that photoreceptor (light-sensing cell) realignment may be better preserved with this approach in certain patients, which can support stronger visual recovery. In more complex cases, a retina specialist may recommend combining scleral buckling with vitrectomy for the most thorough repair possible.
Recognizing the Signs of Retinal Detachment
Retinal detachment is a medical emergency. Knowing the warning signs and acting quickly when they appear significantly improves the chance of preserving good vision.
If you experience any of the following symptoms, seek emergency eye care right away. Retinal detachment does not improve on its own, and waiting even a short time for a routine appointment is not safe.
- A sudden increase in floaters, which are dark spots, strings, or cobweb-like shapes drifting through your vision
- Flashes of light, particularly in your peripheral (side) vision
- A curtain, shadow, or dark area spreading across your visual field
- Sudden blurring or loss of vision in one eye
Retinal detachment often begins with a retinal tear. At this early stage, you may notice a burst of new floaters or brief flashes of light. These symptoms can seem mild and easy to dismiss, but they should never be ignored. If fluid passes through the tear and the retina begins to lift away from the eye wall, symptoms will worsen.
As the detachment spreads, a shadow or curtain appears from the edge of your vision and gradually grows larger. If the detachment reaches the macula, which is the central part of the retina responsible for sharp, detailed vision, central vision will be affected. Surgery performed before the macula detaches is consistently associated with better visual outcomes than surgery performed after macula involvement.
Rhegmatogenous retinal detachment affects roughly 6 to 18 people per 100,000 each year. While not extremely common in the general population, it occurs more frequently among people with known risk factors. Regular dilated eye exams allow a retina specialist to identify retinal tears before they progress to a full detachment, giving patients the best opportunity for a more straightforward and effective repair.
Who Is a Candidate for Scleral Buckling
The decision to use scleral buckling is based on several patient-specific and detachment-specific factors. Our retina specialists carefully evaluate each case to determine the most appropriate surgical strategy for each individual.
Scleral buckling tends to produce the best results in younger patients who still have their natural lens in place. Patients with a single retinal tear or a small cluster of tears located in one region of the retina are often excellent candidates for this approach.
The procedure may be particularly well-suited when the vitreous gel is still firmly attached to the retina. In these cases, surgically removing the vitreous through vitrectomy could introduce additional traction forces that complicate the repair. Avoiding internal surgery helps preserve the natural structure of the eye and can support a cleaner recovery.
Several conditions increase a person's likelihood of developing a retinal detachment. Patients with any of the following should discuss regular monitoring with their eye doctor.
- High myopia, meaning severe nearsightedness typically greater than 6 diopters of correction
- Prior cataract surgery, especially when complications occurred during the procedure
- Eye trauma or physical injury to the eye
- A family history of retinal detachment
- Lattice degeneration, which refers to areas of thinning in the outer portion of the retina
Certain conditions make a successful single-surgery repair more challenging. Proliferative vitreoretinopathy (PVR) is one of the most significant. PVR occurs when scar tissue forms on the surface of the retina following a detachment, creating forces that can cause the retina to re-detach even after a technically successful repair.
Other factors that may reduce the likelihood of single-surgery success include multiple retinal breaks scattered across different areas of the eye, a detachment that has already reached the macula, or a detachment that has been present for an extended period. Our retina specialists assess all of these variables carefully before recommending a surgical plan.
Diagnosing Retinal Detachment
Accurate and thorough diagnosis is essential before surgery can be planned. Our retina specialists use a combination of detailed clinical examination and advanced imaging technology to map the detachment and design an individualized surgical approach.
The primary tool for diagnosing retinal detachment is a comprehensive dilated eye exam. Eye drops are placed in the eye to widen the pupil, allowing the specialist to examine the full retina in detail. Using a specialized lens and an indirect ophthalmoscope, a bright light source worn on the examiner's head, the specialist can view the entire retina from its center to its outermost edges.
Every retinal break is identified, and its size, location, and characteristics are documented. This detailed map directly guides surgical planning, including how the buckle element will be positioned and whether additional techniques will be needed.
When the view of the retina is blocked by blood, cloudy vitreous, or other obstructions, a B-scan ultrasound provides an alternative. This painless, non-invasive test uses sound waves to generate an image of the structures inside the eye and can confirm the presence and position of the detachment.
Optical coherence tomography (OCT) may also be used. OCT produces a high-resolution, cross-sectional image of the retinal layers. It is particularly valuable for determining whether the macula is still attached before surgery, which is one of the strongest predictors of visual recovery after the procedure.
Before any surgery is scheduled, our retina specialists conduct a thorough pre-operative evaluation. This includes precisely mapping every retinal break, measuring the full extent of the detachment, and checking for early signs of PVR or other complications that could affect the surgical approach.
A review of your overall eye health and medical history is also part of this process. Understanding your complete clinical picture ensures that the surgical plan is as safe and effective as possible for your individual situation.
The Scleral Buckling Procedure
Scleral buckling is performed on an outpatient basis, meaning most patients go home the same day. Knowing what to expect at each stage of the procedure can help reduce anxiety and prepare you for a smoother recovery.
You will receive detailed pre-operative instructions, including guidelines on when to stop eating and drinking before the procedure. Scleral buckling is most commonly performed under local anesthesia combined with sedation, which keeps you comfortable and relaxed without requiring general anesthesia. General anesthesia may be used in certain cases, and your surgical team will discuss this with you in advance.
Before surgery begins, eye drops are used to dilate the pupil and numb the surface of the eye. An anesthetic injection is placed around the eye to prevent pain and limit eye movement throughout the procedure.
The procedure begins with a small incision in the conjunctiva, the thin clear membrane covering the white of the eye, to expose the sclera beneath. The eye muscles are gently moved aside to allow the surgeon full access to the surface of the eye.
Using indirect ophthalmoscopy, the specialist carefully locates every retinal break. Cryotherapy is then applied to each break, creating a controlled freeze that promotes a strong and lasting adhesion between the retina and the underlying tissue. The silicone buckle element is positioned and sutured to the sclera directly beneath the break or breaks. When needed, the specialist may also release the fluid that has accumulated under the retina, called subretinal fluid, to help the retina settle against the buckle more quickly.
An advanced variation of scleral buckling uses a chandelier, a small fiber-optic light source placed inside the eye during surgery. Combined with a wide-angle viewing system, this technique provides significantly brighter and more detailed visualization of the retina compared to traditional indirect ophthalmoscopy alone.
The improved view allows the surgeon to identify breaks that might otherwise be difficult to detect and to confirm buckle placement with greater precision. This approach represents a meaningful technical advancement that supports more thorough and confident surgical repair in appropriate cases.
Scleral buckling typically takes between one and two hours, depending on the complexity of the detachment. During the procedure, anesthesia ensures that you remain comfortable and free of pain. After the anesthesia wears off, soreness, tenderness, and swelling around the eye are normal and expected. Prescription medications will be provided to manage discomfort and reduce the risk of infection during the early healing period.
Recovery After Scleral Buckling
Recovery from scleral buckling is a gradual process, and visual improvement takes time. Understanding what is normal during healing helps patients stay calm and recognize the rare situations that require a call to their surgeon.
In the first several days after surgery, moderate discomfort, redness, and puffiness around the eye are normal. The eyelids may appear bruised and swollen. These symptoms are expected and typically begin improving within the first week.
Prescription eye drops, usually including an antibiotic to prevent infection and an anti-inflammatory medication to support healing, will be prescribed and should be used exactly as directed. Activity restrictions will also be given, including avoiding bending at the waist, lifting heavy objects, and strenuous physical activity. Your retina specialist will provide specific guidance based on your individual case.
Vision is usually blurry for the first several weeks after surgery as the retina settles and the eye adjusts. This is a normal part of healing. Visual improvement typically continues over three to six months, and in some cases, gains continue even beyond that period.
Most patients can return to light daily activities within one to two weeks. The silicone buckle remains on the eye permanently in most cases and becomes invisible and undetectable once healing is complete. Follow-up appointments are scheduled frequently during the early weeks of recovery and become less frequent as the eye stabilizes.
Scleral buckling has a well-documented track record. Primary anatomic success rates, meaning the retina remains attached after a single surgery, typically range from approximately 80 to 93 percent. Studies focused on phakic patients with medium-complexity detachments have reported single-surgery success rates approaching 92 percent.
When re-detachment does occur after an initial repair, additional surgery can often restore retinal attachment. The overall success rate across multiple procedures is higher than the rate for a single surgery alone, and our team is experienced in managing even complex or revision cases.
Like all surgical procedures, scleral buckling carries potential risks. Awareness of these complications helps patients know what to monitor during recovery and when to contact their retina specialist promptly.
- Increased myopia (nearsightedness) caused by the buckle slightly altering the shape of the eye
- Double vision (diplopia) from temporary changes in eye muscle position, which usually resolves on its own over weeks to months
- Buckle extrusion, where the silicone element gradually moves toward or through the surface of the eye
- Infection around the buckle element
- Recurrent retinal detachment, particularly when PVR develops following the initial surgery
Living with a Scleral Buckle
For most patients, the scleral buckle becomes a permanent and trouble-free part of the eye. Long-term awareness and ongoing follow-up remain important parts of protecting vision over time.
The silicone buckle sits beneath the conjunctiva and is not visible from the outside. Most patients cannot feel the buckle after the initial healing period ends. The eye gradually adapts to its presence, and it becomes a stable, permanent part of the eye's structure.
Final visual outcomes vary from patient to patient. The most important factors are how long the retina was detached before surgery, whether the macula remained attached at the time of repair, and how thoroughly the retina heals over the months that follow. Patients whose macula was still attached at the time of surgery typically achieve sharper central vision than those who experienced a macula-off detachment.
The scleral buckle is designed to remain in place for life and does not need to be replaced or maintained. In some circumstances, however, removal becomes necessary. These situations include infection around the buckle element, extrusion of the silicone material through the surface of the eye, or persistent double vision that does not improve with time or conservative management.
Factors that increase the likelihood of eventually needing removal include a history of diabetes, prior penetrating eye injury, and having undergone a combined scleral buckling and vitrectomy procedure. Buckle removal is a separate surgical procedure, and your retina specialist will discuss the specific risks and benefits before making any recommendation.
Even after a successful scleral buckling procedure, ongoing follow-up with a retina specialist is essential. The repaired eye carries a higher-than-average risk for future retinal problems, including new tears or early signs of re-detachment. Routine dilated eye exams allow these issues to be identified and addressed early, when treatment is most straightforward.
The opposite eye also deserves close monitoring. Patients who have had a retinal detachment in one eye face an elevated risk of detachment in the other eye as well. Regular exams of both eyes are a central part of a comprehensive, long-term retinal care plan.
When to Seek Urgent Care
Knowing when to contact your retina specialist or go directly to the emergency room is an important part of managing retinal detachment, both before and after surgery.
Retinal detachment will not heal without surgical intervention. If you experience any of the following, do not wait for a routine appointment. Seek emergency eye care immediately.
- A sudden appearance of many new floaters or a dramatic increase in existing floaters
- Flashes of light, especially in your side or peripheral vision
- A curtain, shadow, or dark field spreading across any part of your vision
- Sudden significant loss of vision in one eye
After scleral buckling, certain symptoms require an immediate call to your retina specialist. These could indicate a complication that needs urgent evaluation and treatment.
- Severe eye pain that does not improve with prescribed pain medication
- A notable decrease in vision after an initial period of improvement
- Increasing redness, discharge, or swelling that worsens rather than improves over time
- New floaters or flashes of light appearing after your recovery had otherwise been progressing normally
- A returning shadow or curtain in your field of vision
- Double vision that persists or worsens over time
Frequently Asked Questions
These answers address common questions and practical concerns that patients often raise after learning they need scleral buckling surgery.
Silicone scleral buckle elements contain no metal, so they do not create interference with MRI machines and will not trigger metal detectors at airport security. You do not need to take any special precautions related to the buckle during routine medical imaging or travel. That said, it is always a good practice to inform any physician ordering imaging near your eye that a scleral buckle is present, so they have a complete understanding of your eye history and can interpret results accurately.
The buckle changes the shape of the eye slightly, which almost always shifts the prescription, typically increasing the degree of nearsightedness. The exact change depends on the size and placement of the buckle. Your retina specialist will advise you to wait until your vision has fully stabilized before updating your prescription, and this period often extends several months after surgery. Updating lenses too soon may result in a prescription that continues to change, so patience during this phase pays off in the long run.
Driving is not permitted immediately after surgery because of both the anesthesia used during the procedure and the blurry vision that follows. Your retina specialist will assess your vision at follow-up visits and advise you when it is safe to drive again. Return to work depends largely on what your job requires. Light office work may be possible within one to two weeks for many patients, while physically demanding occupations will require a longer recovery period before clearance. Always follow your surgeon's specific recommendations rather than general estimates.
Blurry vision is expected for the first several weeks and gradually improves over months. The most important single factor in determining how well and how quickly vision returns is whether the macula was still attached at the time of surgery. In a macula-on detachment, where the central retina was never lifted, central vision recovery is typically stronger and faster. In a macula-off detachment, recovery still occurs in most cases but central sharpness may be more limited and take longer to reach its final level. Your retina specialist will give you a realistic picture of what to expect based on your specific situation.
If you notice a returning shadow or curtain in your vision, a sudden increase in floaters, or new flashes of light at any point after your surgery, contact your retina specialist immediately or go to the emergency room. Do not assume these symptoms will pass on their own or that they are a normal part of healing. Re-detachment, while less common after a successful repair, can occur and is treated most effectively when caught early. Prompt evaluation always gives the best chance of a successful outcome from any additional intervention that might be needed.
Expert Retinal Care Across Connecticut
New England Retina Associates has provided specialized retinal care to patients throughout Connecticut since 1995, with a team of fellowship-trained vitreoretinal surgeons dedicated exclusively to conditions of the retina and vitreous. If you have been diagnosed with a retinal detachment, are experiencing warning symptoms, or have been referred by your eye doctor, we welcome you to schedule a consultation at any of our four offices. We accept self-referred and urgent patients and are committed to providing thorough, expert care at every stage of your diagnosis, treatment, and recovery.
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