Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), including, when performed, implant, cryotherapy, photocoagulation, and drainage of subretinal fluid
CPT4 code
Name of the Procedure:
Repair of Retinal Detachment; Scleral Buckling
Common Name(s): Scleral Buckle Surgery
Summary
Scleral buckling is a surgical procedure to repair a detached retina. The surgeon places a silicone band (buckle) around the eye to gently push the wall of the eye against the detached retina, aiding in reattachment. This procedure may include using cryotherapy (freezing) or photocoagulation (laser) to create scar tissue to seal any retinal breaks and draining any fluid beneath the retina.
Purpose
The procedure addresses retinal detachment, a condition where the retina peels away from its supporting tissue. The goals are to reattach the retina, prevent further detachment, and restore or preserve vision.
Indications
- Sudden appearance of floaters or flashes of light
- A shadow or curtain over part of the vision
- Decreased vision, particularly peripherally
- Diagnosed retinal detachment via a comprehensive eye exam
- Patients who are fit for surgery and do not have severe contraindications
Preparation
- Fasting may be required for several hours before surgery.
- Adjustments to regular medications may be necessary (e.g., stopping blood thinners).
- Pre-operative eye examinations and imaging tests, like an ultrasound, are conducted.
- Discussion of the procedure, risks, and consent.
Procedure Description
- Anesthesia: Local anesthesia with sedation or general anesthesia is administered.
- Access: An incision is made in the sclera (white of the eye).
- Buckling: A silicone band is sutured around the eye’s circumference to exert outward pressure.
- Cryotherapy/Photocoagulation: Application of cryotherapy or laser to seal retinal breaks.
- Drainage: Optionally, subretinal fluid may be drained to flatten the retina.
- Closure: Incisions are closed, and the eye is bandaged.
Equipment used includes surgical microscopes, silicone bands, cryoprobes, laser equipment, and drainage instruments.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is performed in a hospital or a specialized surgical center.
Personnel
- Ophthalmic Surgeon
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection
- Bleeding
- Increased intraocular pressure or glaucoma
- Cataract formation
- Double vision
- Recurrence of retinal detachment
- Soreness and redness
- Vision changes or loss
Benefits
- Reattachment of the retina
- Preservation or improvement of vision
- Reduced risk of permanent vision loss
Benefits may be realized within weeks to a few months, depending on individual recovery.
Recovery
- Eye bandage and shield for protection
- Medications, including antibiotics and anti-inflammatory drops
- Avoid strenuous activities and heavy lifting
- Follow-up visits to monitor healing and retinal attachment
- Possible temporary discomfort and vision disturbances
- Full recovery may take several weeks to months
Alternatives
- Pneumatic Retinopexy: Injection of a gas bubble into the eye to reattach the retina.
- Vitrectomy: Removal of vitreous gel, which may sometimes include silicone oil or gas to hold the retina in place.
Each alternative has its own risks and recovery profiles, and suitability depends on the specific case.
Patient Experience
Patients may experience minimal discomfort during the procedure due to anesthesia but may feel pressure. Post-procedure, there may be some pain and discomfort manageable with prescribed medications. Vision may be blurry initially but is expected to improve over time.