“Excellent staff and doctors. Treatment plans detailed and effective. I chose this office as second opinion, should have been first choice.”
Scleral Buckling Surgery for Retinal Detachment
Who Is a Good Candidate?
Not every retinal detachment requires the same surgical approach. Our team carefully evaluates each patient to determine whether scleral buckling is the right choice based on several key factors.
Scleral buckling tends to work best for patients who have their natural lens intact, a single retinal tear or a small cluster of tears in one area, and a relatively uncomplicated detachment. Younger patients often fall into this group.
The procedure may be especially well-suited when the vitreous gel is still firmly attached to the retina. In these situations, removing the vitreous through vitrectomy could introduce additional traction on the retina and increase the risk of complications.
Certain conditions increase a person's chance of developing a retinal detachment. Knowing these risk factors helps identify who should be monitored closely with regular exams.
- High myopia (severe nearsightedness greater than 6 diopters)
- Prior cataract surgery, particularly if there were complications during the procedure
- Eye trauma or injury
- Family history of retinal detachment
- Lattice degeneration, which refers to thin or weakened areas in the peripheral retina
Some conditions can make it harder to achieve reattachment on the first attempt. Proliferative vitreoretinopathy, known as PVR, is the growth of scar tissue on the retinal surface after a detachment. PVR is one of the most common causes of re-detachment following surgery.
Other factors that may affect outcomes include multiple retinal breaks in different quadrants of the eye and a detachment that has already involved the macula (the central part of the retina responsible for sharp vision). Our Retina Specialists weigh all of these factors carefully when planning surgery.
Recognizing Retinal Detachment
Retinal detachment is a true eye emergency. Knowing the warning signs and acting quickly gives you the best chance of preserving vision and limiting permanent damage.
If you notice any of the following symptoms, contact a Retina Specialist or go to an emergency room right away. Do not wait to see if symptoms improve on their own.
- A sudden increase in floaters (spots, threads, or cobweb-like shapes moving across your vision)
- Flashes of light, especially in your peripheral (side) vision
- A shadow, curtain, or dark area spreading across your visual field
- Sudden vision loss in one eye
Retinal detachment often begins with a retinal tear. In the early stage, you may notice new floaters or brief flashes of light that seem minor and easy to dismiss. However, these early symptoms should never be ignored.
If fluid continues to pass through the tear, the detachment spreads. A shadow or curtain effect may begin at the edge of your vision and gradually move inward. If the detachment reaches the macula, central vision becomes affected. Prompt treatment before the macula detaches is strongly associated with better visual recovery.
Rhegmatogenous retinal detachment is the most common form of retinal detachment and occurs when a tear or hole allows fluid to lift the retina away from the eye wall. While it is not common in the general population, the risk is meaningfully higher among people with the risk factors described above.
Regular dilated eye exams are one of the most effective ways to identify retinal tears before they progress to a full detachment. Our team uses advanced imaging technology, including optical coherence tomography (OCT) and wide-field retinal imaging, to detect early changes in the retina.
Diagnosis and Pre-Surgical Testing
Before scleral buckling surgery can be planned, our Retina Specialists perform a thorough evaluation to map the full extent of the detachment and identify every retinal break. Accurate diagnosis is essential for planning the right surgical approach.
Diagnosis begins with a comprehensive dilated eye exam. Drops are placed in the eye to widen the pupil, giving the Retina Specialist a clear view of the entire retina. Using a specialized lens and an indirect ophthalmoscope (a bright light source worn on the head), the specialist examines the retina in detail.
During this exam, the specialist records the location, size, and number of retinal tears or holes, as well as the extent of the detachment. This information forms the foundation of the surgical plan.
In some cases, blood or cloudy vitreous gel can block the view of the retina. When this happens, a B-scan ultrasound is used. This painless, non-invasive test uses sound waves to create an image of the retina's position inside the eye.
OCT imaging may also be performed. OCT creates a highly detailed cross-sectional image of the retina layers and is especially useful for determining whether the macula is still attached. Whether the macula is on or off at the time of surgery is one of the most important factors in predicting visual recovery.
Before scheduling surgery, the Retina Specialist reviews your complete eye health and medical history. The evaluation includes a careful assessment of all retinal breaks, an estimate of the detachment's extent, and a check for PVR or other complicating factors.
Your specialist will explain the planned surgical approach and discuss what to expect before, during, and after the procedure. This is also an opportunity to ask any questions you may have.
What Happens During Scleral Buckling Surgery
Scleral buckling is a carefully planned, outpatient surgical procedure performed by our Retina Specialists. Understanding each step of the process can help reduce anxiety and prepare you for the day of surgery.
You will be asked to avoid eating or drinking for several hours before surgery. When you arrive, eye drops will be used to dilate your pupil and numb the surface of the eye. An anesthetic injection may be placed around the eye to prevent pain and limit eye movement during the procedure.
Scleral buckling is most often performed under local anesthesia with sedation to keep you comfortable and relaxed. General anesthesia may be used in select cases based on individual patient needs.
The Retina Specialist begins by making a small incision in the conjunctiva, which is the clear membrane covering the white part of the eye. This exposes the sclera underneath. The eye muscles are gently separated to allow full access around the eye.
Using indirect ophthalmoscopy, the specialist precisely locates every retinal break. Cryotherapy is applied to each break, creating a controlled freeze that promotes strong adhesion between the retina and the tissue behind it. The silicone buckle element is then placed over the break and sutured to the sclera. If needed, a small amount of fluid may be drained from beneath the retina to help it settle against the buckle.
Our team may use a technique known as chandelier-assisted scleral buckling in certain cases. A small fiber-optic light source is placed inside the eye, and a wide-angle viewing system is used alongside it. This combination provides a brighter, more detailed view of the retina during surgery compared to traditional indirect ophthalmoscopy alone, which can improve precision and outcomes.
Scleral buckling surgery typically takes one to two hours depending on the complexity of the detachment. The procedure is performed on an outpatient basis, meaning most patients go home the same day.
Because anesthesia is used, you will not feel pain during the surgery. After the anesthesia wears off, some soreness, swelling, and tenderness around the eye are expected. Your Retina Specialist will prescribe medications to manage discomfort and reduce the risk of infection.
Recovery and What to Expect
Recovery after scleral buckling takes several weeks to months, with vision gradually improving as the retina heals. Knowing what is normal and what requires urgent attention helps you recover safely and confidently.
In the first several days, it is normal to experience moderate discomfort, redness, puffiness around the eyelid, and a bruised appearance around the eye. These are expected signs of healing and improve steadily over time.
You will be prescribed eye drops, typically an antibiotic and an anti-inflammatory medication, to support healing and prevent infection. Your Retina Specialist will provide specific instructions about activity restrictions, including avoiding heavy lifting, bending at the waist, and strenuous exertion during the initial recovery period.
The initial healing phase generally lasts two to four weeks. During this time, vision is usually blurry as the eye adjusts and the retina continues to reattach. Visual improvement can continue for several months following surgery.
Most patients can return to light daily activities within one to two weeks. Full visual recovery takes longer, and the silicone buckle element remains on the eye in most cases. Once healing is complete, the buckle is not felt by the patient and is not visible to others.
Scleral buckling has a well-established record of success for appropriate candidates. Primary anatomic success rates (meaning the retina stays attached after a single surgery) are generally high, particularly in younger patients with straightforward detachments and their natural lens intact.
If the retina re-detaches after the initial surgery, additional surgery can often achieve successful reattachment. Our Retina Specialists will discuss realistic expectations for your specific situation before surgery.
As with any surgery, scleral buckling carries some risks. Understanding them helps you know what to watch for during recovery and when to contact our office.
- Increased myopia (nearsightedness) due to mild changes in the shape of the eye from the buckle
- Double vision (diplopia) from changes in eye muscle position, which often resolves over time
- Buckle extrusion, a rare situation where the silicone element gradually works through the surface of the eye
- Infection around the buckle element
- Recurrent retinal detachment, particularly if PVR develops after surgery
Living with a Scleral Buckle
For most patients, the silicone buckle remains in place for life and becomes a stable, comfortable part of the eye's structure. Understanding what to expect long-term helps set realistic expectations and supports continued eye health.
The scleral buckle sits beneath the conjunctiva and is not visible from the outside. Most patients cannot feel the buckle after the initial healing period ends. Over time, the eye fully adapts to the buckle, and it does not need to be replaced or maintained.
Your final visual outcome depends on several key factors, including how long the retina was detached before surgery, whether the macula was involved, and how well your retina heals over time. Patients whose macula remained attached before surgery (known as a macula-on detachment) generally recover sharper vision than those whose macula had already separated.
In some cases, the scleral buckle may need to be removed months or years after the original surgery. Reasons for removal include infection around the buckle, extrusion of the element through the surface of the eye, or persistent double vision that does not resolve on its own.
Risk factors that can increase the likelihood of needing removal include diabetes, a history of penetrating eye injury, and having undergone a combined surgical procedure. Buckle removal is performed as a separate surgery, and your Retina Specialist will thoroughly explain the risks and benefits before proceeding.
Long-term follow-up with a Retina Specialist is an important part of life after scleral buckling surgery. Even after a successful repair, the treated eye remains at higher risk for future retinal problems, including new tears or re-detachment.
The other eye also deserves close monitoring. People who have experienced a retinal detachment in one eye have a higher risk of detachment in the fellow eye over time. Regular dilated eye exams and retinal imaging allow our team to detect any early changes before they become serious, giving you the best chance of preserving vision in both eyes.
When to Seek Urgent Care
Knowing when to seek immediate help after scleral buckling surgery is as important as the surgery itself. Some symptoms during recovery are normal, while others require prompt attention from your Retina Specialist.
If you have not yet been diagnosed and are experiencing sudden new floaters, flashes of light, a curtain-like shadow across your vision, or sudden vision loss in one eye, do not wait for a scheduled appointment. Seek care immediately at a retina practice or an emergency room. Retinal detachment does not resolve on its own and progresses without treatment.
After surgery, contact your Retina Specialist right away if you experience any of the following. These symptoms may indicate a complication that requires urgent evaluation.
- Severe eye pain that does not improve with prescribed pain medication
- A noticeable decrease in vision
- Increasing redness, swelling, or discharge from the eye, which may indicate 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 over time
When in doubt, it is always better to contact our office and be evaluated. Early intervention can prevent a minor issue from becoming a serious one.
Frequently Asked Questions
These questions address practical decisions and concerns that often come up before and after scleral buckling surgery, going beyond the general information covered above.
The answer depends on your specific anatomy, age, lens status, and the complexity of the detachment. Scleral buckling is generally favored for younger patients with a clear vitreous gel and a straightforward tear pattern, while vitrectomy may be preferred for more complex detachments, detachments with cloudiness inside the eye, or patients who have already had cataract surgery. In some cases, both procedures are combined. Your Retina Specialist will explain which approach is most appropriate for your situation after a thorough examination.
Yes, it is very likely. The buckle changes the shape of the eye slightly, which typically causes an increase in myopia, or nearsightedness. Your prescription may also shift in astigmatism. You should wait until the eye has fully healed and vision has stabilized before updating your glasses or contact lenses. This generally takes several months after surgery, and your Retina Specialist will let you know when your vision is stable enough to get a new prescription.
If your surgeon injected a gas bubble into your eye during surgery, flying can be dangerous and is typically restricted until the gas bubble has been fully absorbed. Changes in cabin pressure at altitude can cause the gas to expand, raising pressure inside the eye to unsafe levels. If no gas was used, travel restrictions may be less strict, but you should always confirm with your Retina Specialist before boarding a flight during recovery.
The risk of re-detachment is real but relatively low after a successful scleral buckling procedure. The most common reason for re-detachment is the development of PVR (proliferative vitreoretinopathy), where scar tissue grows on the retinal surface and pulls it away from the eye wall again. Your Retina Specialist monitors for early signs of PVR during follow-up visits. If re-detachment does occur, additional surgery can often achieve successful reattachment. Patients who develop new symptoms during recovery should not wait before seeking care.
For the vast majority of patients, the silicone buckle remains in place indefinitely without causing problems. The material is biocompatible, meaning the body tolerates it well over time. It does not set off metal detectors and is compatible with MRI imaging. Buckle removal is only considered if a specific complication arises, such as extrusion, infection, or persistent double vision. Most patients never require removal and are not aware the buckle is present after the first few months of healing.
Some blurriness, mild light sensitivity, and a gritty or sore feeling in the eye are expected during the first few weeks. However, a sudden worsening of vision, a new shadow or curtain in your visual field, new floaters or flashes, or increasing pain and redness are not normal and should prompt an immediate call to our office. When uncertain, contacting your Retina Specialist is always the right choice. We would rather evaluate a concern that turns out to be nothing than have a complication go unaddressed.
Contact Atlantic Retina Center
At Atlantic Retina Center, our fellowship-trained Retina Specialists focus exclusively on the retina, vitreous, and macula, bringing specialized expertise and advanced technology to every patient across the Delmarva peninsula. If you have been diagnosed with a retinal detachment, are experiencing warning symptoms, or have questions about scleral buckling surgery, we encourage you to contact our team promptly. Early evaluation and treatment give you the best possible chance of protecting your vision for the long term.