What is Scleral Buckle Surgery?

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A scleral buckle is a surgery performed for the repair of retinal detachment. A scleral buckle is a small silicone strip that is placed like a belt around the outside of the eye, attached to the sclera (the white outer layer of the eye) with stitches. The scleral buckle is usually left in place permanently. It is used to indent the outside of the eye which relieves the pull (traction) on the retina, allowing the retinal tear to settle against the wall of the eye. Freezing treatment or laser is then applied to the retinal tears to cause them to seal. In some cases, fluid is drained from the eye, and air or gas is injected into the eye during this surgery. The buckle will not be visible from the outside of the eye after the surgery.

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Anatomy of the Eye

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IRIS              The colored circle in the front of the eye

PUPIL          The black circle which gets bigger and smaller to control the amount of light entering the eye

LENS           Located just behind the iris and focuses light

VITREOUS  Gel-like substance which fills the space in the eye between the lens and the retina

RETINA       A very thin, clear tissue lining the inner eyewall

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Why do I need a scleral buckle?

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Scleral buckles are used to repair retinal detachments. Certain factors make you at greater risk of developing a retinal detachment. These include:

 

• Nearsightedness

• Other eye disorders such as uveitis, lattice degeneration

• Previous cataract surgery

• Increased age

• Diabetes

• Trauma

 

Most of the time retinal detachments happen spontaneously, however, sometimes trauma to the eye can be the cause.

 

Scleral buckle may be performed alone or in combination with vitrectomy surgery. The advantages of scleral buckling alone are less risk of complications related to entering the eye, such as endophthalmitis. In younger patients, it avoids the risk of cataract development that is present with vitrectomy. In patients with lattice degeneration (weak spots of the retina) or abnormal vitreous interface, it provides 360 degrees of support of the vitreous base and peripheral retina. If the procedure is done without the use of gas there is no need for post-operative positioning or air travel restriction, which is the case if gas is inserted during surgery. Visual recovery is often quicker after scleral buckle surgery than a vitrectomy.

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What are the risks of Scleral Buckling?

 

Although most patients do well with scleral buckling, as with any surgery, complications can happen. The risk of complications may depend on your age, underlying medical conditions, previous eye history, and the specifics of your retinal detachment.  Risks of scleral buckle include but are not limited to:

 

• Bleeding (hemorrhage) in your eye

• Increased pressure in your eye

• Double vision

• Recurrent retinal detachment or new retinal tears requiring more surgery

• Increased nearsightedness

• Proliferative vitreoretinopathy (scarring under the retina)

• Loss of vision or loss of the eye

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How to prepare for surgery

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• A prescription for eye drops will be faxed to your pharmacy. Please ensure you have picked this up in advance of your surgery date as you will need to start the eye drops one day prior to surgery and continue after.

• ALL blood thinners must be discontinued 3-14 days prior to surgery depending on the drug you are taking. This includes Aspirin, Warfarin, Plavix, Xarelto, Eliquis, Pradaxa, Coumadin, etc. Please let        Dr. Varma or staff know immediately if you are on a blood thinner. Please discontinue all herbal remedies 2 weeks prior to surgery.

• Please have nothing to eat or drink after midnight.

• Take your usual medications on the morning of your surgery except blood thinners.

• Shower or bathe either the morning of surgery or the night before.

• You should not bring valuables or jewelry to the Pasqua Hospital.

• Do not wear perfume, make-up, or face cream.

• Hearing aids should be worn, however will be removed from the operative side during the surgery. It will be replaced immediately after surgery is complete.

• You may wear wigs or dentures as these do not need to be removed.

• Your surgery will be performed at the Pasqua Hospital 4101 Dewdney Avenue. 306-766-2222.

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On the Day of Surgery

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• Please go to Pasqua Hospital and register in the admitting department on the main floor.  You will then proceed to Day Surgery on the second floor.

• Bring a complete list of your medications and your valid health card.

• You will be admitted to a bed in the Day Surgery Unit and will be asked to change into a gown. You may have only one visitor with you. This may change due to the pandemic situation.

• You will lie down in a hospital bed. The nurse will start an IV and you will be hooked up to monitors in Day Surgery.

• If you are booked for a local anesthetic, Dr. Varma will freeze your eye with a needle given under the eye (a retrobulbar block). Prior to the needle, the anesthetist will offer you sedation.

• You will be taken into the operating room by the porter and introduced to the OR nurses, the anesthetist, and Dr. Varma.

• Once the team is ready to begin, a surgical checklist is completed, where the patient name, side of surgery, and details of the surgery are confirmed prior to starting the procedure.

 

How is the Surgery Done?

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This surgery is done either with local freezing or a general anesthetic. During this procedure, Dr. Varma will cover you with a sterile drape. Only your eye is exposed. Your eye is held open with an instrument called an eyelid speculum. You cannot see what is happening during the surgery and you cannot move your eye due to the freezing/or anesthetic. An incision is made in the surface layer of your eye. The silicone buckle is positioned under the four muscles that move the eye. Dr. Varma will then use freezing or laser to treat your retinal tears.

In some cases, you may require air or gas to seal the holes in the retina and keep the retina in place. The gas is slowly absorbed from the eye and is replaced by normal eye fluids over two weeks to two months following surgery. You may be asked to sleep on your side or in a facedown position after surgery for 24 hours to 5 days. You cannot fly on an airplane with a gas bubble in your eye.

 

Post-operative Instructions

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• It is hospital policy that YOU MUST HAVE SOMEONE TO DRIVE YOU HOME. You are not able to drive yourself.

• You will be at the hospital for approximately 4 hours.

• You will leave the hospital with a patch over your eye.

• You will be discharged from the hospital the day of your surgery.

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PLEASE BRING all eye drops you are using to all appointments with Dr. Varma.

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Dressing / Eye Patch

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Remove the patch in the morning and resume your eye drops. After removing the patch do not reapply it. The eye should be left uncovered. Your vision will be very poor immediately following surgery. You may only see light and motion. The healing process can be several months.

 

Your eye will be red and swollen for a few weeks. Your eye will feel gritty or mildly irritated. You will have tiny stitches on the surface of the eye which will feel like an eyelash is stuck in your eye. It is common for patients to still have flashes and floaters in the eye after surgery. This usually disappears with time. However, these symptoms occasionally remain for a year or more.

 

DO NOT RUB your eyes or squeeze your eyelids tight – you may use a newly opened bottle of artificial tears to relieve any irritation. Always wash your hands with soap and water before touching your eyes. You can dab away the discharge with a tissue. You may notice blood-stained discharge, this is normal. Do not rub the eye. Your eye may be sticky and crusty, especially in the morning. 

 

Do NOT use tap water to clear your eye. You can boil water and let it cool to clean your eye.

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• Use a cold pack for 10-15 minutes for comfort. You can place ice in a Ziplock bag wrapped in a towel.

• You might have pain after your surgery. You will be given Tylenol 3 to help make you comfortable. Once you are home you can use what you would normally use to control a headache (Tylenol or Advil)

• You should call the office or Dr. Varma as soon as possible if there is any sudden loss of vision, increase in pain, or discharge from the eye, especially if it is green or yellow and sticky.

• Wear dark glasses if light bothers you.

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Activities within the first week

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• No heavy lifting (nothing more than 35lbs).

• Cleanse lids with clean tissue to remove debris.

• Showering/bathing and washing your hair is permitted. Do not get water in your eye for the first week (wash so that the water runs off the back of your head and not in your face).

• Do not take very hot showers and baths as it may cause the blood vessels in the eye to dilate (open) and result in bleeding.

• Walking, reading, watching television as before surgery is permitted.

• No swimming or hot tub use.

• Do not wear eye make-up for one week.

• Do not drive a vehicle for 24 hours after surgery.

• You may continue your medications as before surgery. This includes any eye drops you were taking prior to surgery (glaucoma eye drops).

• Check with Dr. Varma before engaging in physical activity and lifting. Do not do any contact sports. It is important to wear proper eye protection when playing racquet sports.

• Check with Dr. Varma prior to your surgery about time off work. An off-work letter can be provided to you and should be requested PRIOR to your surgery. If you require insurance forms to be filled out, please bring them to the office as soon as possible.

• You may be asked to position in a certain manner. This is to help the retina heal. Dr. Varma will advise you if head positioning is required either prior to surgery or before being discharged from the hospital.

 

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WARNING:

• Since gas expands at high altitudes, a dangerously high rise in the eye pressure can result in loss of vision.

• DO NOT fly if you have gas inserted in your eye during surgery.

 

  Call immediately if you experience:

• Sudden loss of vision

• Severe pain not controlled by Tylenol / Advil / Aspirin

• Signs of infection (bleeding, redness, swelling, yellow discharge)

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Call the office at 306-522-1092   Monday to Friday 8 AM - 4:30 PM

For after-hours emergencies only call 306-450-4441

(this emergency number will not be answered during business hours)