Abstract
Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.
Highlights
A possible reason for this shift from scleral buckling towards vitrectomy could be related to the fact that interest in scleral buckling has slightly declined over the time, due to difficulties in both teaching and learning this surgery, which depends on great experience in binocular indirect ophthalmoscopy and scleral indentation
Scleral buckling continues to have a relevant role in clinical practice and it should be the treatment of choice for specific types of Rhegmatogenous retinal detachment (RRD), ensuring better visual and anatomical outcomes compared to pars plana vitrectomy
These findings are in line with those reported by the SPR study and the European Vitreo-Retinal Society report, corroborating the fact that scleral buckling could provide better outcomes compared with vitrectomy in phakic eyes with uncomplicated or moderately complicated RRDs
Summary
Rhegmatogenous retinal detachment (RRD) surgery mainly includes three different surgical approaches, namely pneumoretinopexy, scleral buckling (SB) and pars plana vitrectomy (PPV). The encircling band is usually closed through a silicone sleeve: its closure represents one of the final steps of the surgery because it leads to an intraocular pressure rise Segmental circumferential buckles, such as strips and tires, are usually placed underneath the encircling band at retinal breaks’ locations, with the purpose of sealing the breaks and reducing the risk of the fish-mouthing of a retinal tear. Traditional scleral buckling surgery usually involves: conjunctival peritomy; recti muscles isolation; localization of each retinal break; encircling band application and buckles positioning to seal each break properly; accurate retinopexy to all breaks (can be based on either cryotherapy –more commonly- or laser photocoagulation); an additional step performed by most surgeons is the evacuative puncture.
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