Scleral Buckle Surgery for Retinal Detachment
What Scleral Buckle Surgery Treats
A retinal detachment occurs when the retina separates from the supportive tissue beneath it, cutting off its blood supply and causing progressive vision loss. You may notice a shadow or curtain moving across your field of vision, a sudden increase in floaters, or flashes of light. Retinal detachment occurs in approximately 1 in 10,000 people per year (American Society of Retina Specialists). Without prompt treatment, the detached retina cannot function, and permanent vision loss in the affected eye is the usual outcome. At Greenwich Ophthalmology Associates, our fellowship-trained retina specialist Dr. Jerry Tsong evaluates and manages retinal detachments at our Stamford, CT office, providing patients across the greater New York and Connecticut region with access to specialized retina care.
A scleral buckle is a small piece of silicone or sponge material that we suture to the outer wall of the eye, called the sclera. The buckle gently pushes the wall of the eye inward toward the detached retina, bringing the retina back into contact with its underlying support layer. Once the retina is repositioned, the eye can begin to heal and restore nourishment to the retinal tissue. The buckle remains permanently in place but is not visible from the outside and does not change the appearance of the eye.
Scleral buckle surgery is most commonly recommended for retinal detachments caused by retinal tears or breaks, a type known as rhegmatogenous retinal detachment. It is particularly well suited for younger patients, those with clear natural lenses, and detachments that involve the lower portion of the retina. In some cases, scleral buckling may be combined with other procedures such as vitrectomy or cryotherapy to achieve the best result. Dr. Tsong, who trained at MIT, Harvard Medical School, and the Doheny Eye Institute, evaluates the location, size, and characteristics of each detachment to determine whether a scleral buckle is the most appropriate approach for your situation.
The Procedure and What to Expect
We will perform a thorough examination of your retina using advanced imaging and diagnostic tools to map the detachment and identify all retinal breaks. You will receive instructions on eating, drinking, and medication use in the hours leading up to surgery. Most scleral buckle procedures are performed on an outpatient basis, meaning you will go home the same day. You will need to arrange for someone to drive you to and from the surgical facility.
Scleral buckle surgery is typically performed under local anesthesia with sedation, so you will be comfortable and relaxed but awake. The surgeon places the silicone buckle around the outside of the eye, positioning it precisely to support the area of detachment. Cryotherapy or laser is applied to seal the retinal tear and create a permanent bond between the retina and the tissue beneath it. In some cases, fluid that has collected beneath the retina is drained to help the retina settle back into place. The procedure generally takes one to two hours depending on the complexity of the detachment.
After surgery, your eye will be patched and you will be given drops to prevent infection and reduce inflammation. Mild to moderate discomfort, swelling, and redness around the eye are normal during the first week. Most patients can return to light daily activities within a few days, though you should avoid heavy lifting, bending, and strenuous exercise for several weeks. We will schedule follow-up visits at our Stamford office to monitor the position of the retina and track your healing. Because Greenwich Ophthalmology Associates provides comprehensive routine and specialty eye care under one roof, your post-operative visits and any ongoing retina monitoring take place in the same location where your general eye care is managed. Full visual recovery can take several months, and the degree of improvement depends on how long the retina was detached and whether the central macula was involved.
Results, Risks, and Alternatives
The primary goal of scleral buckle surgery is to reattach the retina and prevent further vision loss. In many cases, scleral buckling successfully reattaches the retina in a single procedure. Patients whose macula was still attached at the time of surgery tend to have the best visual outcomes. When the macula has already detached, the surgery can still preserve peripheral vision and prevent total vision loss, though central vision recovery may be limited. It is important to understand that the procedure is designed to preserve the vision you have rather than guarantee restoration of vision already lost.
As with any surgical procedure, scleral buckle surgery carries some risks. These may include increased nearsightedness due to the change in the eye's shape, double vision from temporary swelling of the eye muscles, infection, bleeding, or increased eye pressure. In a small percentage of cases, the retina may re-detach and require additional surgery. Cataract development can also occur over time, particularly in patients who have not yet had cataract surgery. Dr. Tsong discusses all risks thoroughly before surgery so that you can make a fully informed decision, and he is available to answer questions in English or Mandarin Chinese.
Scleral buckling is one of several surgical options for retinal detachment repair. Pneumatic retinopexy is a less invasive office-based procedure that uses a gas bubble to push the retina into place and may be appropriate for smaller, less complex detachments. Pars plana vitrectomy involves removing the vitreous gel from inside the eye and using gas or silicone oil to hold the retina in position during healing. In some situations, a combination of vitrectomy and scleral buckling provides the best chance of a successful outcome. Dr. Tsong will recommend the approach best suited to your specific type of detachment based on a thorough evaluation using our in-office diagnostic technology, including OCT imaging, fluorescein angiography, and B-scan ultrasonography.
Conditions Related to Retinal Detachment
Most retinal detachments begin with a retinal tear or hole that allows fluid to pass beneath the retina. Tears often develop when the vitreous gel pulls away from the retina during a posterior vitreous detachment, a common age-related change. When a retinal tear is identified before the retina detaches, laser treatment or cryotherapy can often seal the tear and prevent detachment from occurring. This is why prompt evaluation of new flashes or floaters is so important.
Certain factors increase the likelihood of developing a retinal detachment. High myopia, or significant nearsightedness, thins the retina and makes it more vulnerable to tears. Previous eye surgery, a history of retinal detachment in the other eye, a family history of detachment, and direct eye trauma all raise the risk. Patients with giant retinal tears or lattice degeneration may also be at elevated risk and benefit from regular monitoring.
Retinal detachment is a time-sensitive condition. If you experience a sudden increase in floaters, new flashes of light in your peripheral vision, or a shadow or curtain spreading across your field of view, contact Greenwich Ophthalmology Associates at our Stamford office or seek emergency eye care right away. With over 50 years of service in the greater New York and Connecticut region and a team that includes a fellowship-trained retina specialist, we are equipped to evaluate urgent retinal symptoms and determine the most appropriate course of action. Early treatment gives the best chance of preserving vision and may allow for less invasive repair options before the detachment progresses.
Frequently Asked Questions
Most patients experience little to no pain during the procedure because local anesthesia and sedation are used. After surgery, you may have soreness, a feeling of pressure around the eye, and mild swelling for the first several days. These symptoms are typically well managed with prescribed eye drops and over-the-counter pain medication.
Initial healing takes about two to four weeks, during which you should avoid strenuous activity, heavy lifting, and bending at the waist. Most patients can return to desk work and light daily routines within one to two weeks. Full visual recovery may take three to six months, and your doctor will monitor your progress at regular follow-up appointments.
In most cases, the scleral buckle is left permanently in place. It is made of biocompatible silicone that the body tolerates well over the long term. Removal is uncommon and typically only considered if the buckle causes persistent discomfort, infection, or other complications, which occurs in a small minority of patients.
Re-detachment is possible but uncommon. The success rate for retinal reattachment with scleral buckling is high, and most patients achieve a stable result after one procedure. If the retina does re-detach, additional surgery such as vitrectomy can be performed. Keeping all follow-up appointments at our Stamford office allows Dr. Tsong to monitor your retina closely and address any early signs of recurrence.
Visual recovery depends on several factors, including how long the retina was detached and whether the macula was involved. Patients whose macula remained attached before surgery generally recover better central vision. In all cases, the primary goal is to preserve your current vision and prevent further loss, and many patients do experience meaningful improvement over the months following surgery.
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