Last updated: 02/17/2009

Scleral buckling is performed in an operating room under general or local anesthetic. Immediately before the procedure, patients are given eye drops to dilate the pupil to allow better access to the eye. The patient is given a local anesthetic....

After the eye is numbed, the surgeon cuts the eye membrane, exposing the sclera. If bleeding or inflammation blocks the surgeon's view of the retinal detachment or hole, he or she may perform a vitrectomy before scleral buckling.

Vitrectomy is necessary only in cases in which the surgeon's view of the damage is hindered. The surgeon makes two incisions into the sclera, one for a light probe and the other for instruments to cut and aspirate. The surgeon uses a tiny, guillotine-like device to remove the vitreous, which he then replaces with saline. After the removal, the surgeon may inject air or gas to hold the retina in place.

After, the surgeon is able to see the retina, he or she will perform one of two companion procedures.

• Laser photocoagulation. The laser is used when the retinal tear is small or the detachment is slight. The surgeon points the laser beam through a contact lens to burn the area around the retinal tear. The laser creates scar tissue that will seal the hole and prevent leakage. It requires no incision.
• Cryopexy. Using a freezing probe, the surgeon freezes the outer surface of the eye over the tear or detachment. The inflammation caused by the freezing leads to scar formation that seals the hole and prevents leakage. Cryopexy is used for larger holes or detachments, and for areas that may be hard to reach with a laser.

After the surgeon has performed laser photocoagulation or cryopexy, he or she indents the affected area of the sclera with silicone. The silicone, either in the form of a sponge or buckle, closes the tear and reduces the eyeball's circumference. This reduction prevents further pulling and separation of the vitreous. Depending on the severity of the detachment or hole, a buckle may be placed around the entire eyeball.

When the buckle is in place, the surgeon may drain subretinal fluid that might interfere with the retina's reattachment. After the fluid is drained, the surgeon will suture the buckle into place and then cover it with the conjunctiva. The surgeon then inserts an antibiotic (drops or ointment) into the affected eye and patches it.

For less severe detachments, the surgeon may choose a temporary buckle that will be removed later. Usually, however, the buckle remains in place for the patient's lifetime. It does not interfere with vision. Scleral buckles in infants, however, will need to be removed as the eyeball grows.