Scleral buckling for rhegmatogenous retinal detachment

Abstract

The principle of rhegmatogenous retinal detachment (RRD) repair is rooted in the concept of closing the retinal break(s) and relieving the vitreous traction on the flap(s). However, the methods by which to repair a RRD vary considerably. While scleral buckles were formerly the mainstay of treatment, small-gauge instrumentation has made pars plana vitrectomy the preferred technique for a majority of retina specialists. Nevertheless, scleral buckle surgery either alone or in combination with pars plana vitrectomy is an essential component of retinal detachment repair and should be in the arsenal of all vitreoretinal surgeons. The principle of accurate identification and localization of retinal breaks is as pertinent to scleral buckling today as it was when first emphasized by Jules Gonin in 1921. Precisely identifying areas of retinal pathology is critical for choosing the appropriate buckling element. Consequently, meticulous preoperative and intraoperative examinations are essential to maximizing surgical success. Silicone rubber is the preferred material used for scleral buckle explants, either in the form of compressible sponges or solid elements. Compared to other materials, silicone rubber has been found to be biologically inactive, chemically inert, and is less prone to bacterial infection (Michels retinal detachment, St. Louis, 1997). Scleral buckles may be applied in a segmental (either circumferential or radial) or encircling fashion. The latter may be used as a solitary treatment or in combination with pars plana vitrectomy repair.