What is Scleral Buckling?
Scleral Buckling is a surgical procedure used to treat retinal detachment by placing a silicone band around the eye to gently push the wall of the eye against the retina. This helps the retina reattach and heal properly, preserving vision.
Scleral Buckling in India
Picture the retina as wallpaper on a slightly damp wall. When a tear opens in that wallpaper, fluid creeps behind it, and the wallpaper starts peeling away from the wall. The problem is not just the tear. It is that the wall is no longer in contact with the paper where it should be.
Scleral buckling solves this by pushing the wall in. A silicone band or sponge is stitched onto the outside of the eye (the sclera) to create a gentle, permanent indentation. That indentation pushes the sclera inward, towards the detached retina, closing the retinal break and letting the retina reattach as the trapped subretinal fluid gets absorbed.
It is one of the oldest techniques in retinal surgery, and it remains one of the most useful, particularly for specific detachment patterns in young, phakic eyes. At Vasan Eye Care, scleral buckling is performed by fellowship-trained vitreoretinal surgeons using established materials, cryotherapy or laser to seal retinal breaks, and, where needed, subretinal fluid drainage. The technique is especially valuable when preserving the patient’s natural crystalline lens is a priority, because vitrectomy accelerates cataract formation while scleral buckling does not.
Retinal detachment is a sight-threatening emergency that strikes a significant number of Indians every year. The highest-risk groups are familiar: high myopes, patients who have had cataract surgery, those with prior ocular trauma, and anyone with a family history. Late presentation is common in India, partly because early symptoms (flashes, floaters, peripheral shadows) are easily dismissed or misread. Patients often arrive weeks after the detachment started, by which point the macula is already involved.
Indian vitreoretinal units follow protocols developed by the Vitreo-Retinal Society of India and international bodies. The decision between scleral buckling, pars plana vitrectomy, or a combined approach is made case by case, based on break location, number and size of breaks, extent of detachment, lens status, and the presence of proliferative vitreoretinopathy.
Scleral buckling is often the preferred tool for peripheral breaks in young, phakic patients, where preserving the natural lens is a genuine advantage. Vitrectomy, by contrast, tends to be preferred for complex cases, pseudophakic eyes, and detachments with significant vitreous traction. Neither is universally better. The choice is clinical.
Types of Scleral Buckling Available in India
| Type | Configuration | Typical Use | Advantages |
|---|---|---|---|
| Segmental Buckle | Localised silicone sponge | Isolated retinal breaks | Limited extent of surgery; preserves ocular motility |
| Encircling Buckle | 360-degree silicone band | Multiple breaks, wide detachments | Relieves vitreous traction circumferentially |
| Combined Encircling + Segmental | Band with radial or circumferential sponge | Complex detachments | Addresses multiple breaks and supports vitreous base |
| Scleral Buckle with Vitrectomy | Buckle combined with pars plana vitrectomy | Complex or combined pathology | Handles both peripheral breaks and vitreous disease |
Scleral Buckling – How the Procedure Works?
Scleral buckling is performed under local or general anaesthesia. The conjunctiva is opened, and the four rectus muscles are identified and isolated with sutures for orientation. Retinal breaks are localised using indirect ophthalmoscopy and marked on the sclera. Cryotherapy or laser is applied around each break to create a chorioretinal scar, which is what will ultimately hold the retina in place permanently.
A silicone band or sponge is then sutured onto the sclera directly over the area of the retinal breaks. The band is tightened gently to indent the sclera inward, closing the breaks against the retinal pigment epithelium. If significant subretinal fluid is trapped, a controlled drainage is performed through a small scleral opening. The conjunctiva is then closed, and antibiotic and anti-inflammatory agents are administered.
The band stays in place permanently, hidden under the conjunctiva. Over weeks, tissue grows around it and encapsulates it. Most patients forget it is there.
When Is Scleral Buckling Necessary? Signs You Need Treatment
Scleral buckling is indicated for rhegmatogenous retinal detachment, which typically presents with:
- Sudden showers of floaters
- Flashes of light, especially in the peripheral vision
- A dark curtain or shadow moving across the field of vision
- Progressive vision loss in one eye
Young patients with clear lenses, detachments caused by peripheral breaks, and cases without significant vitreous haemorrhage are often considered ideal candidates for primary scleral buckling. Patients with any of these symptoms should seek urgent ophthalmic care, ideally within 24 to 48 hours. The speed with which treatment is started genuinely shapes the final visual outcome. Waiting out “a weekend to see if it settles” is how a repairable detachment becomes a salvage case.
Scleral Buckling: Step-by-Step Procedure
- Detailed pre-operative evaluation: dilated fundoscopy, ultra-wide-field imaging, B-scan ultrasonography where needed.
- Pre-operative counselling: diagnosis, surgical approach, expected outcomes, and risks discussed openly.
- On the day of surgery: anaesthesia administered, eye prepared and draped.
- Conjunctiva opened, rectus muscles isolated with bridle sutures.
- Retinal breaks localised with indirect ophthalmoscopy and treated with cryotherapy.
- Silicone buckle sutured into position over the breaks.
- Buckle tightened to achieve appropriate indentation; subretinal fluid drained if needed.
- Conjunctiva closed and medications administered.
- Post-operative follow-up on day one, at one week, one month, and further intervals after that.
How Much Does Scleral Buckling Cost in India?
Cost depends on whether the procedure is isolated or combined with vitrectomy, the type of anaesthesia used, and the hospital category.
| Procedure | Indicative Cost (INR) | Typical Inclusions |
|---|---|---|
| Primary Scleral Buckle | 45,000 to 90,000 | Surgery, anaesthesia, buckle material, follow-ups |
| Scleral Buckle + Vitrectomy | 70,000 to 1,40,000 | Combined surgery, consumables, post-op medications |
| Complex Scleral Buckling | 60,000 to 1,10,000 | Additional consumables, longer operating time |
Insurance coverage is often available for retinal detachment surgery. Patients should confirm specifics with their insurer before booking.
Post-Surgery Care and Recovery
What to Expect After Scleral Buckling?
The operated eye is usually patched for a day. Moderate pain, redness, swelling, double vision, and a foreign body sensation from the buckle are all common in the first one to two weeks. None of this means something is wrong; it is the expected course.
Vision may stay blurred for several weeks as the retina reattaches and subretinal fluid absorbs. Some patients notice a shift in their refraction, often a small increase in myopia, because the encircling band slightly elongates the eye. Final visual recovery can take several months. Patience in this window is warranted.
Post-Operative Care Tips
- Use prescribed antibiotic, steroid, and cycloplegic drops on schedule and attend every follow-up.
- Avoid heavy lifting, bending, and strenuous exercise for three to four weeks.
- Sleep with the head slightly elevated to reduce swelling.
- Avoid swimming and contact sports for at least six weeks.
- Report any new floaters, flashes, worsening vision, severe pain, or signs of infection immediately.
- Update spectacle prescriptions only after refraction stabilises, usually six to eight weeks after surgery.
References
American Academy of Ophthalmology. Retinal Detachment Preferred Practice Pattern.
Vitreo-Retinal Society of India. Clinical Guidelines on Retinal Detachment Surgery.
Schepens CL et al. Scleral Buckling Surgery: Historical and Current Perspectives.
Indian Journal of Ophthalmology. Outcomes of Scleral Buckling in Indian Eyes.
Royal College of Ophthalmologists. Guidelines for the Management of Retinal Detachment.
Frequently Asked Questions
Yes. Despite the rise of vitrectomy as the dominant retinal procedure, scleral buckling remains a well-established technique, particularly for young phakic patients and for certain peripheral detachments where preserving the lens matters. Calling it outdated is fashionable but wrong.
Yes. The silicone band or sponge is typically left in place permanently and becomes encapsulated by the surrounding tissue. It is rarely removed, and only if it causes a complication such as infection or extrusion.
The buckle is placed behind the conjunctiva and is generally not visible. Some patients feel it as a mild fullness or slight discomfort in the first few weeks, which typically settles with time. Long term, most people forget it is there.
Often, slightly. An encircling band tends to elongate the eye by a small amount, which can increase myopia by a dioptre or so. New spectacles are prescribed once refraction stabilises, typically six to eight weeks after surgery.
In appropriately selected cases, primary reattachment rates are high, typically 85 to 90 percent with a single procedure. The final visual outcome depends largely on whether the macula was detached, and for how long. A macula that has been off for days recovers less than one that was still attached at the time of surgery. This is why early presentation matters so much.
Most patients are discharged the same day or after an overnight stay, depending on the anaesthetic used and the surgeon’s protocol.
Yes, frequently. In complex detachments with vitreous haemorrhage or proliferative vitreoretinopathy, a combined buckle-plus-vitrectomy is often the preferred approach. The two techniques complement each other: the buckle addresses peripheral breaks and relieves traction, while the vitrectomy clears the vitreous and handles the posterior segment.
Desk-based work is generally possible within one to two weeks. Physical jobs, particularly those involving heavy lifting or dusty environments, may need four to six weeks off.
Possible complications include infection, buckle extrusion, double vision (usually from muscle imbalance), refractive change, raised eye pressure, and, rarely, recurrence of detachment. The surgeon should discuss these in detail before surgery. Nothing on this list is a secret; ask about any of it that concerns you.
Patients with high myopia or other risk factors should have regular dilated retinal examinations of both eyes, for life. Prompt laser treatment of any new retinal breaks in the fellow eye can prevent progression to full detachment. If you have had a detachment in one eye, treat the other eye as a known risk factor, not an afterthought.
References
American Academy of Ophthalmology. Retinal Detachment Preferred Practice Pattern.
Vitreo-Retinal Society of India. Clinical Guidelines on Retinal Detachment Surgery.
Schepens CL et al. Scleral Buckling Surgery: Historical and Current Perspectives.
Indian Journal of Ophthalmology. Outcomes of Scleral Buckling in Indian Eyes.
Royal College of Ophthalmologists. Guidelines for the Management of Retinal Detachment.
