Scleral Buckle Surgery

This chapter details the types, surgical techniques, and complications of scleral buckles in retinal detachment repair. Placed externally on the sclera, the buckle pushes the sclera, choroid and retinal pigment epithelium inward with the aim of sealing the retinal break. The two main types of scleral buckles are segmental and encircling. Cryopexy is often used in conjunction with scleral buckling with or without subretinal fluid drainage. Some cases of retinal detachment are better suited for scleral buckles than pars plana vitrectomy including cases with adherent posterior hyaloid in young patients where retinal detachment is caused by atrophic retinal holes or retinal dialyses rather than tractional retinal tears. Although their indications are slightly limited, anatomical outcomes of scleral buckle surgery in primary retinal detachment are at least similar to pars plana vitrectomy with superior functional outcomes and lower rates of retinal displacement. Scleral buckle surgery is relatively safe, but there are some risks associated with the procedure particularly when external drainage of subretinal fluid is attempted, including subretinal hemorrhage and retinal incarceration.