Scleral Buckling Surgery for Retinal Detachment
Understanding Scleral Buckling
Scleral buckling is an external eye surgery. Rather than working inside the eye, the retina specialist works on the outside surface. A silicone element, either a small sponge or a solid band, is stitched onto the sclera (the white outer wall of the eye). This creates a gentle inward push that brings the eye wall closer to the detached retina.
The procedure is most often used to treat rhegmatogenous retinal detachment. This is the most common type. It is caused by a tear or hole in the retina that allows fluid to seep underneath and separate the retina from the tissue behind it.
When the retina tears, the gel inside the eye (the vitreous) can pull on the retina. This allows fluid to pass through the tear. The buckle counteracts this pulling force by pushing the eye wall inward toward the retina. This closes the retinal tear from the outside and stops fluid from flowing underneath.
Once the tear is sealed, a natural pump system in the retinal pigment epithelium (the layer of cells behind the retina) absorbs the trapped fluid. Over time, the retina flattens back against the eye wall and reattaches. Cryotherapy (a freezing treatment) or laser is also applied around the tear to create a lasting seal.
Retina specialists choose from different buckle types depending on the detachment. The two main approaches are segmental buckles and encircling bands.
- A segmental buckle is a small piece of silicone sponge placed directly over the retinal tear. It is used when the detachment is localized to one part of the eye.
- An encircling band is a thin silicone strip that wraps around the entire circumference of the eye. It is used for more extensive detachments or when there are multiple tears.
Vitrectomy (a surgery to remove the gel inside the eye) has become more common for retinal detachment repair. However, scleral buckling offers distinct advantages in certain situations. For younger patients who still have a natural lens and have a straightforward detachment, scleral buckling can be the preferred approach.
Research suggests that photoreceptor re-alignment may be better after scleral buckling compared to vitrectomy. This could contribute to better visual outcomes in some patients. In complex cases, a retina specialist may combine both procedures.
Who Is a Candidate and Risk Factors
Scleral buckling tends to work best for specific types of retinal detachment. Younger patients with their natural lens intact and a relatively simple detachment are often the best candidates. Patients with a single retinal tear or a small number of tears in one area also tend to have excellent results.
The procedure may be especially useful when the vitreous gel is still firmly attached to the retina. In these situations, removing the vitreous through vitrectomy could create additional traction and complications.
Several factors increase the likelihood of developing a retinal detachment. Understanding these risk factors can help identify people who should be monitored closely.
- High myopia (severe nearsightedness, greater than 6 diopters)
- Previous cataract surgery, especially if there was vitreous loss during the procedure
- Eye trauma or injury
- Family history of retinal detachment
- Lattice degeneration (thin areas in the peripheral retina)
Certain conditions can make scleral buckling less likely to succeed on the first attempt. Proliferative vitreoretinopathy, or PVR, is a condition where scar tissue forms on the retina after a detachment. PVR is one of the most common reasons for re-detachment after surgery.
Other factors that can reduce success rates include having multiple retinal breaks in different locations and a detachment that has already affected the macula. A retina specialist will evaluate these factors when deciding on the best surgical approach.
Signs and Symptoms of Retinal Detachment
Retinal detachment is a medical emergency. The sooner it is treated, the better the chances of preserving vision. See a retina specialist or go to the emergency room immediately if you experience any of the following symptoms.
- A sudden increase in floaters (spots or cobweb-like shapes drifting across your vision)
- Flashes of light, especially in your peripheral vision
- A curtain-like shadow or dark area spreading across your field of vision
- Sudden vision loss in one eye
Retinal detachment often starts with a retinal tear. At this early stage, you may notice new floaters or brief flashes of light. These symptoms can seem minor and may be easy to dismiss. However, if fluid seeps through the tear, the symptoms will worsen.
As the detachment spreads, you may notice a shadow or curtain effect creeping in from the side of your vision. If the detachment reaches the macula, central vision will be affected. Prompt treatment before the macula detaches is associated with better visual outcomes.
Rhegmatogenous retinal detachment affects roughly 6 to 18 people per hundreds of thousands each year (NIH, StatPearls, 2024). While it is not extremely common in the general population, it is more frequent among people with the risk factors described above. Regular dilated eye exams can identify retinal tears before they lead to full detachments.
Diagnosis and Testing
A retina specialist diagnoses retinal detachment through a comprehensive dilated eye exam. Drops are placed in the eye to widen the pupil, allowing the specialist to see the retina in detail. Using a special lens and a bright light source called an indirect ophthalmoscope, the specialist can examine the entire retina.
The exam allows the specialist to identify any retinal tears, holes, or areas of detachment. The location, size, and number of breaks are all recorded. These details help determine the best surgical plan.
In some cases, the view of the retina may be blocked by blood or cloudy vitreous gel. When this happens, an ultrasound of the eye (B-scan ultrasonography) can show the position of the retina. This painless test uses sound waves to create an image of the structures inside the eye.
Optical coherence tomography, or OCT, may also be used. This imaging test creates a detailed cross-sectional picture of the retina. It is especially helpful for determining whether the macula is still attached, which is a critical factor in predicting visual recovery.
Before scleral buckling surgery, the retina specialist performs a thorough evaluation. This includes mapping every retinal break, assessing the extent of the detachment, and checking for signs of PVR. The specialist will also review your overall eye health and medical history to ensure you are ready for surgery.
The Scleral Buckling Procedure
Scleral buckling is typically performed as an outpatient procedure, meaning you go home the same day. You will receive instructions to avoid eating or drinking for a set number of hours before surgery. The procedure is usually done under local anesthesia with sedation, though general anesthesia may be used in some cases.
Eye drops will be given to dilate the pupil and numb the eye. An anesthetic injection may be placed around the eye to prevent pain and movement during surgery.
The surgery follows a series of carefully planned steps. First, the retina specialist makes a small incision in the conjunctiva (the clear membrane covering the white of the eye) to expose the sclera. The eye muscles are gently isolated to allow access around the eye.
Next, the specialist locates all retinal breaks using indirect ophthalmoscopy. Cryotherapy is applied to each break, creating a controlled freeze that will form a strong adhesion between the retina and the underlying tissue. The silicone buckle element is then positioned and sutured to the sclera. In some cases, the specialist may drain subretinal fluid to help the retina settle against the buckle.
A newer approach called chandelier-assisted scleral buckling uses a small fiber-optic light placed inside the eye. A wide-angle viewing system is also used. This gives the retina specialist a brighter, more detailed view of the retina during the procedure. Studies suggest this technique offers better visualization compared to traditional indirect ophthalmoscopy alone.
Scleral buckling surgery typically takes between one and two hours. The procedure is not painful during surgery due to anesthesia. After the anesthesia wears off, you can expect some discomfort, swelling, and soreness around the eye. Your retina specialist will prescribe medications to manage pain and prevent infection.
What to Expect After Surgery
Most patients experience moderate discomfort, redness, and swelling for the first several days. The eyelids may be puffy and the eye may look bruised. These symptoms are normal and improve gradually. Prescription eye drops, typically including an antibiotic and an anti-inflammatory medication, will be given to support healing.
You will be asked to limit physical activity and avoid bending, lifting heavy objects, or straining. Your retina specialist will give specific instructions about positioning and activity restrictions.
The initial healing period lasts about two to four weeks. During this time, vision is usually blurry as the eye recovers and the retina reattaches. Visual improvement can continue for several months after surgery. The buckle element stays on the eye in most cases and is not felt or visible once healing is complete.
Most patients can return to light daily activities within one to two weeks. Full recovery of vision takes longer. Follow-up appointments are scheduled frequently in the first few weeks and then become less frequent as healing progresses.
Scleral buckling has a strong track record. Primary anatomic success rates, meaning the retina stays attached after a single surgery, range from 80% to 93% (Retina journal, 2010). In phakic patients with medium-complexity detachments, the Primary Retinal Detachment Outcomes Study reported a single surgery success rate of 91.7% (Graefe's Archive for Clinical and Experimental Ophthalmology, 2025).
If the retina re-detaches, additional surgery can often reattach it. The overall success rate with multiple procedures is higher than the single-surgery rate.
As with any surgery, scleral buckling carries some risks. Understanding these potential complications helps you know what to watch for during recovery.
- Increased myopia (nearsightedness) due to the buckle changing the shape of the eye
- Double vision (diplopia) from changes in eye muscle position, which usually resolves over time
- Buckle extrusion, where the silicone element works its way through the surface of the eye
- Infection around the buckle element
- Recurrent retinal detachment, especially if PVR develops
Living with a Scleral Buckle
The silicone buckle typically remains on the eye for life. It sits underneath the conjunctiva and is not visible to others. Most patients cannot feel the buckle after the initial healing period. Over time, the eye adapts to the buckle and it becomes a stable part of the eye's structure.
Your final visual outcome depends on several factors. These include how long the retina was detached, whether the macula was involved, and how well the retina heals. Patients whose macula was still attached before surgery generally have better visual outcomes.
In some cases, the scleral buckle may need to be removed months or years after the original surgery. Reasons for removal include infection, extrusion of the buckle through the surface of the eye, or persistent double vision. Risk factors for needing removal include diabetes, a history of penetrating eye injury, and having had a combined procedure.
Buckle removal is a separate surgery. Your retina specialist will discuss the risks and benefits if removal becomes necessary.
Long-term follow-up with a retina specialist is important after scleral buckling. Even after successful surgery, the treated eye remains at higher risk for future retinal problems. The other eye also deserves close monitoring. People who have had a retinal detachment in one eye have an increased risk in the fellow eye.
Regular dilated eye exams allow a retina specialist to detect any new retinal tears, thinning, or early signs of re-detachment before they become serious.
When to See a Retina Specialist
If you experience any symptoms of retinal detachment, such as new floaters, flashes of light, or a shadow across your vision, see a retina specialist or go to the emergency room immediately. Retinal detachment does not improve on its own and requires prompt surgical treatment to prevent severe vision loss.
Contact your retina specialist right away if you notice any of the following after scleral buckling surgery. These symptoms could indicate a complication that needs urgent attention.
- Severe eye pain that does not improve with prescribed medication
- A significant decrease in vision
- Increasing redness or discharge from the eye, which could signal infection
- New flashes of light or a sudden increase in floaters
- A shadow or curtain returning in your visual field
- Double vision that persists or worsens
Questions and Answers
During the procedure, anesthesia prevents pain. After surgery, most patients experience moderate soreness, tenderness, and swelling around the eye for several days. This discomfort is typically managed with prescription pain medication and cold compresses. The level of post-operative discomfort varies, but it generally improves steadily during the first week.
Scleral buckling changes the shape of the eye slightly, which often increases myopia (nearsightedness). This means your glasses or contact lens prescription will likely change. Your retina specialist will advise you on when to get a new prescription. This is typically after the eye has fully healed and vision has stabilized, which may take several months.
Re-detachment is possible, though most scleral buckle surgeries are successful on the first attempt. The main cause of re-detachment is proliferative vitreoretinopathy (PVR), where scar tissue grows on the retina surface. If re-detachment occurs, additional surgery is usually recommended. Your retina specialist will monitor you closely during recovery to detect any early signs of problems.
Vision is typically blurry for the first several weeks after scleral buckling. Gradual improvement can continue for three to six months or longer. The final level of vision depends on factors such as how long the retina was detached and whether the macula was involved. Patients with a macula-on detachment generally recover sharper vision than those with macula-off detachments.
In most cases, the silicone buckle remains on the eye indefinitely. It does not need to be replaced and does not wear out. The buckle sits beneath the surface of the eye and is not visible or noticeable once healing is complete. Removal is only performed if a specific complication arises, such as infection or extrusion.