Scleral Buckling 101

When primary scleral buckling should be considered – and how to succeed

By Alexander Ringeisen, Edwin Ryan and David Almeida

February 2018

At a Glance

  • We might be in the age of vitrectomy, but we believe that scleral buckling is the treatment of choice for certain retinal detachments
  • But which patients are the best candidates for a primary scleral buckle and how should surgery be approached?
  • We overview when primary buckling should be considered and provide guidance on which techniques will help success, as well as when to avoid a primary buckle
  • Welcome to scleral buckling 101 for the senior ophthalmology resident and the junior retina fellow!

Rhegmatogenous retinal detachment (RRD) repair is one of the most common indications for retinal surgery. A multitude of anatomical presentations exist and therefore it is best treated with an individualized approach as opposed to a standardized procedure. Over the past 25 years, pars plana vitrectomy (PPV) has gained favor with vitreoretinal surgeons and is being used increasingly more than scleral buckling (SB) for RRD repair (1). Why has PPV gained favoritism? A variety of elements come into play, including the increased availability of small gauge instrumentation, improved viewing and lighting systems, industry support, as well as economic factors. However, we believe that SB should remain the treatment of choice for certain types of primary RRDs, and that it should remain in the vitreoretinal surgeon’s armamentarium for years to come. As such, it is imperative that current and future retinal fellows gain the skills necessary to perform the procedure.

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