Scleral Buckle

October 25, 2007

The application of a scleral buckle (note, this is a procedure, not an implant), or “scleral buckling,” is a surgical technique used to repair retinal detachments. It was first used experimentally by ophthalmic surgeons in 1937. By the early 1960s, scleral buckling had become the method of choice when the development of new materials, particularly silicone, offered surgeons new opportunities for improving their outcomes.

The application of a scleral buckle (note, this is a procedure, not an implant), or "scleral buckling," is a surgical technique used to repair retinal detachments. It was first used experimentally by ophthalmic surgeons in 1937. By the early 1960s, scleral buckling had become the method of choice when the development of new materials, particularly silicone, offered surgeons new opportunities for improving their outcomes. The buckling element is usually left in place permanently. The element pushes in, or "buckles," the sclera toward the middle of the eye. This buckling effect on the sclera relieves the pull (traction) on the retina, allowing the retinal tear to settle. The buckle effect may cover only the area behind the detachment, or it may encircle the eyeball like a ring. The buckle holds the retina against the sclera until scarring seals the tear. It also prevents fluid leakage, which could cause further retinal detachment.Scleral buckles come in many shapes and sizes. An encircling band is usually a thin silicone band sewn around the circumference of the sclera of the eye. In rare instances, a metallic clip may be used for scleral buckling. Some metallic clips may pose a risk to patients undergoing MRI procedures.

TANTALUM CLIPS

Tantalum is quite ductile and malleable, so it can be bent a number of times without breaking. Tantalum clips were found to be less bulky than sutures for scleral buckles, allowing the surgeon to adjust the tension of the circling band. Furthermore, tantalum clips do not cause tissue reaction and do not harbor infection for scleral buckles. Because tantalum is a nonferrous metal (nonmagnetic), tantalum clips are considered safe for patients undergoing MRI. Dr. Shellock is an adjunct clinical professor of radiology and medicine at the Keck School of Medicine and director of MRI studies of Biomimetic MicroElectronic Systems (BMES) Implants, National Science Foundation BMES Engineering Research Center, University of Southern California, and Institute for Magnetic Resonance Safety, Education, and Research.
www.MRIsafety.com
www.IMRSER.org

BIBLIOGRAPHY

Bakshandeh H, Shellock FG, Schatz CJ, Morisoli SM. Metallic clips used for scleral buckling: ex vivo evaluation of ferromagnetism at 1.5 T. J Magn Reson Imaging 1993;3:559. Lincoff H. Radial buckling in the repair of retinal detachment. Int Ophthalmol Clin 1976;16:127-34.Michels RG. Scleral buckling methods for rhegmatogenous retinal detachment. Retina 1986;6:1-49.