Scleral Buckle

Why is a Scleral Buckle Needed?

Scleral buckle surgery is required when the retina detaches from its underlying support layers, leading to vision loss. If not treated in time, a retinal detachment can cause irreversible damage, leading to permanent blindness. The medical principle behind the procedure involves indenting the scleral wall to reduce vitreoretinal traction, close retinal breaks, and allow subretinal fluid to reabsorb naturally. According to published ophthalmology studies, early surgical intervention is the most critical factor in vision preservation. The scleral buckle surgery success rate of 80 to 90% underscores its proven effectiveness. This surgery is particularly beneficial for patients who experience:

• Retinal tears or holes

that allow fluid to seep underneath, causing the retina to lift off.

• Rhegmatogenous retinal detachment 

The most common type, caused by age-related changes in the vitreous gel inside the eye. Beyond scleral buckling, comprehensive retinal tear treatment may incorporate laser photocoagulation or cryotherapy to seal retinal breaks. Research highlights that untreated rhegmatogenous detachment results in near-total vision loss in the affected eye, making prompt intervention critical.

• Trauma-induced retinal detachment

Can occur due to direct impact on the eye. Specific causes include sports injuries such as boxing, racquet sports and martial arts, as well as falls, car accidents and physical assault. Traumatic retinal detachment accounts for a significant proportion of detachment cases in younger, active populations, as documented in peer-reviewed literature.

• High Myopia and the Risk of Retinal Detachment

High myopia (severe nearsightedness) increases the risk of retinal detachment due to the elongation of the eyeball. Studies show that patients with myopia greater than 6 dioptres face a 5 to 10 times higher lifetime risk of retinal detachment than emmetropic individuals, attributable to peripheral retinal thinning and lattice degeneration.

• Risk of Retinal Detachment Following Previous Eye Surgeries

Previous eye surgeries may lead to retinal instability. For example, retinal detachment after cataract surgery is a recognised complication, particularly in highly myopic patients. Glaucoma surgery and prior vitreoretinal procedures also predispose the eye to subsequent detachment, requiring closer long-term retinal monitoring.

By reinforcing the eye’s structure and supporting the retina’s position, scleral buckling prevents further detachment and helps maintain vision stability.

Benefits of the Scleral Buckle Surgery

Scleral buckle surgery has several advantages that make it a preferred option for treating retinal detachment. Research assessing scleral buckle surgery quality of life demonstrates high patient satisfaction scores, with the majority of patients returning to normal daily activities within weeks and reporting significantly reduced anxiety related to vision loss.

• High Success Rate and Recovery Expectations

Published data from leading ophthalmology centres confirms a scleral buckle surgery success rate of 80 to 90% for primary reattachment, with overall anatomical success exceeding 95% when combined with adjunct procedures. Most patients experience meaningful functional vision recovery within weeks of surgery.

• Long-term stability

The buckle remains permanently in place without interfering with daily activities. Long-term follow-up studies spanning a decade confirm stable retinal attachment and good central vision. Understanding life after scleral buckle surgery reassures patients that most resume reading, driving and moderate physical activities after full recovery.

• Preservation of natural eye structures

The procedure does not remove the vitreous gel, unlike vitrectomy. The ability to preserve the vitreous gel prevents accelerated nuclear sclerosis (cataract), commonly associated with vitrectomy, a particularly important advantage for younger phakic patients.

• Compatibility with Other Retinal Treatments

Scleral buckle is compatible with laser photocoagulation or cryotherapy to enhance retinal attachment. International retinal surgery guidelines support combining these adjuncts in cases with multiple or large retinal breaks.

• Minimized risk of cataract formation

Cataract formation is a recognised side effect of vitrectomy-based surgeries. Comparative studies in leading ophthalmology journals indicate significantly lower rates of cataract progression in scleral buckle patients over a five-year follow-up period.

Preparation Before the Procedure

Before undergoing scleral buckle surgery, a comprehensive preoperative assessment is necessary. Preoperative preparation for high-risk patients with diabetes, cardiovascular conditions, or bleeding disorders, additional specialist consultation and anaesthesia review are required to minimise operative risk.

• A complete eye examination

To determine the extent of retinal detachment and assess retinal health. This includes dilated fundoscopy, slit-lamp biomicroscopy and indirect ophthalmoscopy to map retinal breaks precisely. A retinal health test such as electroretinography may also be conducted to assess baseline retinal function before surgery.

• Retinal imaging tests,

Optical coherence tomography (OCT) and fundus photography visualise the detachment in detail. High-resolution OCT angiography now enables surgeons to identify subclinical detachments and map pathology with greater precision than previously possible.

• Reviewing medical history

Identifying underlying conditions that could affect surgery or healing, including systemic hypertension, diabetes mellitus, and medications with ocular implications.

• Stopping blood-thinning medications

Aspirin or anticoagulants may need to be stopped to prevent excessive bleeding during surgery, in coordination with the patient’s prescribing physician.

• Fasting guidelines

Patients receiving general anaesthesia must observe fasting for general anaesthesia, which typically requires abstaining from food and fluids for 6 to 8 hours before surgery, in accordance with standard anaesthetic protocols. Individualised fasting instructions are provided during the pre-admission assessment.

Scleral Buckle Treatment Procedure

The scleral buckle treatment procedure is performed in several carefully coordinated steps. Experienced retinal surgeons apply their sub-speciality expertise to achieve precise buckle positioning, which directly influences surgical success. When planning the procedure, the scleral buckle vs vitrectomy comparison helps the surgical team select the least invasive yet most effective approach for each patient.

• Anaesthesia Options for Scleral Buckle Surgery:

The patient may receive local anaesthesia for scleral buckle surgery with sedation, or general anaesthesia, depending on case complexity and patient preference. Local anaesthesia is increasingly preferred for adult patients for its safety advantages and shorter recovery, while general anaesthesia is typically used for paediatric patients or complex, prolonged repairs.

• Making Small Incisions for Precise Buckle Placement

The surgeon makes precise incisions in the white part of the eye to create space for buckle placement. Advanced microsurgical instruments, including high-magnification operating microscopes and fibre-optic illumination, provide millimetre-level accuracy while minimising trauma to surrounding tissues.

•  Placement of the Scleral Buckle:

A flexible silicone band is positioned around the eye to support the retina’s reattachment. The buckle is individually sized and positioned based on the patient’s ocular anatomy, with custom scleral buckle fitting ensuring precise alignment with the retinal break. The surgeon’s skill in buckle sizing and suture tension directly determines primary reattachment outcomes.

• Draining Subretinal Fluid for Better Retina Attachment:

If necessary, excess fluid beneath the retina is drained to allow better adherence. This step is executed with meticulous care to minimise the risk of choroidal haemorrhage, managed through established surgical technique by experienced retinal surgeons

• Cryotherapy or laser treatment:

Retinal tears are sealed using cryotherapy or laser photocoagulation to reinforce attachment. The decision between cryotherapy vs laser treatment for retinal detachment is guided by the location and size of the break. Cryotherapy is favoured for anterior breaks, while laser photocoagulation is preferred for more posterior pathology. Both modalities deliver equivalent long-term retinopexy outcomes when correctly applied.

• Closing the incisions:

The surgeon carefully sutures the incisions, and antibiotic ointment is applied to prevent infection. The choice between absorbable sutures for scleral buckle and non-absorbable nylon sutures is guided by conjunctival health and surgeon preference. Meticulous closure maintains buckle position and prevents wound-related complications.

Precautions and Care After the Procedure

Proper post-operative care is essential to ensure a successful recovery. Ophthalmologists recommend a structured aftercare plan with vigilant monitoring for retinal re-detachment, infection, and elevated intraocular pressure throughout the first month after surgery.

• Use prescribed eye drops

Prescribed eye drops reduce inflammation and prevent infection. A combination of antibiotic and corticosteroid drops is typically prescribed to maintain a clean, anti-inflammatory healing environment.

• Avoid strenuous activities and heavy lifting

Patients should avoid strenuous activities and heavy lifting for at least several weeks after surgery. Specific post-surgery activity restrictions include avoiding swimming, contact sports, heavy gym workouts, and bending the head below waist level. Non-compliance significantly increases the risk of elevated intraocular pressure and re-detachment.

• Wear an eye shield at night

Wearing an eye shield at night prevents accidental rubbing during sleep. The eye shield for scleral buckle recovery is recommended for at least two weeks post-surgery, or longer as advised by the treating surgeon.

• Adhere to head positioning guidelines

Head positioning guidelines, if recommended, facilitate fluid drainage and healing. Medical professionals confirm that proper head positioning for retinal surgery recovery helps residual subretinal fluid migrate away from the macula. Specific positioning may involve a face-down or lateral head position for several days postoperatively.

• Attend follow-up visits

Regular follow-up visits allow the surgeon to monitor progress and detect complications early. Recommended timelines for follow-up visits for scleral buckle surgery typically include appointments at one week, one month, three months, and six months post-surgery. Research confirms that structured follow-up significantly reduces rates of undetected re-detachment.

Result of Scleral Buckle Treatment

Most patients notice improvement in vision within a few weeks. Some may require additional treatments such as vitrectomy if complications arise. With proper care, scleral buckle surgery successfully prevents further detachment and stabilises vision. Long-term prognosis data indicate that over 90% of patients maintain stable retinal attachment at five years, with the best visual outcomes seen in those who receive treatment before macular detachment occurs.

Types of Retinal Detachments Treated with Scleral Buckle

Scleral buckle surgery is effective for various types of retinal detachments. Expert retinal specialists note that rhegmatogenous detachments respond most consistently to scleral buckling, with primary success rates of 80 to 90% in published clinical series.

• Rhegmatogenous detachment

caused by retinal tears and fluid accumulation.

• Tractional detachment

due to scar tissue pulling on the retina, often seen in diabetic retinopathy.

• Exudative detachment

 resulting from fluid leakage beneath the retina due to inflammation or tumors.

Scleral Buckle vs. Vitrectomy – Which is Better?

Scleral buckle and vitrectomy serve different purposes:

• Scleral buckle is ideal for simpler retinal detachments

particularly in younger patients, as it preserves the vitreous gel.

• Vitrectomy is better suited for complex cases

such as those involving severe traction or multiple retinal breaks.

Risks and Complications of Scleral Buckle Surgery

While highly effective, the risks of scleral buckle surgery and possible scleral buckle surgery complications should be clearly understood before proceeding. Rare but important complications include choroidal detachment, buckle erosion through the conjunctiva, and buckle migration, all of which require close postoperative monitoring.

• Infection – Infection at the surgical site or within the eye is rare with modern antibiotic prophylaxis protocols.

• Increased intraocular pressure (glaucoma) – Elevated intraocular pressure may be temporary or, in rare cases, may require ongoing management.

• Double vision – Diplopia may occur due to temporary extraocular muscle disturbance and usually resolves within weeks.

• Bleeding inside the eye – Vitreous haemorrhage generally clears spontaneously over several weeks.

• Need for additional surgery in rare cases – In cases where primary reattachment is not achieved, vitrectomy or buckle revision may be necessary.

Success Rate and Long-Term Outcomes of Scleral Buckle Surgery

The long-term scleral buckle surgery success data from major ophthalmology institutions consistently reports primary anatomical success rates of 80 to 90%, with overall rates exceeding 95% following combined procedures. Most patients maintain stable vision and low recurrence rates over decade-long follow-up. Regular retinal examinations post-surgery are essential for sustained retinal health.

Why Choose Dr Agarwals Eye Hospital for Scleral Buckle Surgery?

Dr Agarwals Eye Hospital is a trusted destination for scleral buckle surgery, combining clinical expertise with patient-centred care:

• Expert retinal specialists with decades of sub-specialty experience in vitreoretinal surgery and a high annual volume of complex retinal procedures.
• Advanced surgical technology, including wide-angle viewing systems, intraoperative OCT, and state-of-the-art cryotherapy units.
• Personalized patient care and follow-up, with structured postoperative monitoring at every stage of recovery.
• High surgical success rates, consistently meeting or exceeding published benchmarks, with a documented institutional track record of superior scleral buckle surgery success rate outcomes across thousands of procedures.

Conclusion

Scleral buckle surgery remains one of the most reliable and time-tested treatments for retinal detachment, particularly for rhegmatogenous cases in younger patients. Its capacity to preserve vitreous gel, achieve high long-term anatomical success, and minimise the complications associated with intraocular surgery continues to make it a compelling first-line option for many patients. Advances in imaging, microsurgical technique, and postoperative care have further strengthened outcomes in recent years. If you notice any warning signs such as sudden floaters, flashes of light, or a shadow across your vision, seek immediate ophthalmological evaluation. Early treatment remains the single most important factor in preserving sight after retinal detachment.