Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures


Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures.

Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus.

Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB.

Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.


Rhegmatogenous Retinal Detachment, Scleral Buckle, Scleral Suture, Scleral Tunnels, Strabismus

1. Rezaei KA, Abrams GW. The history of retinal detachment surgery. In: Kreissig I, editor. Primary retinal detachment [Internet]. Berlin/Heidelberg: Springer-Verlag; 2005 [cited 2019 Oct 13]. p. 1–24. Available from: http://link.springer. com/10.1007/3-540-26801-4_1

2. New York Society for Clinical Ophthalmology; April 7, 1952. Am J Ophthalmol 1953;36:520–524.

3. Michels RG. Scleral buckling methods for rhegmatogenous retinal detachment. Retina 1986;6:1–49.

4. Farr AK, Guyton DL. Strabismus after retinal detachment surgery. Curr Opin Ophthalmol 2000;11:207–210.

5. Sauer A, Bouyon M, Bourcier T, Speeg-Schatz C. [Diplopia complicating scleral buckling surgery for retinal detachment]. J Fr Ophtalmol 2007;30:785–789.

6. Ryan E, Joseph D, Ryan C, Forbes N, Yonekawa Y, Mittra R, et al. Primary retinal detachment outcomes study (PRO Study): methodology and overall outcomes—PRO study report #1. Ophthalmol Retina; In press.

7. Landa G, Benevento J, Rosen R. Sutureless belt loops versus sutured buckle technique in combination with vitrectomy for retinal detachment repair: a comparative analysis. Ophthalmologica 2018;239:225–230.

8. Ganekal S, Nagarajappa A. Strabismus following scleral buckling surgery. Strabismus 2016;24:16–20.

9. Akbari MR, Mirmohammadsadeghi A, Makateb A, Ghassemi F, Norooznezhad AH, Khodabande A, et al. Ocular movement disorders following scleral buckling surgery: a case series study. J Curr Ophthalmol 2019;31:195–200.

10. Wu T-EJ, Rosenbaum AL, Demer JL. Severe strabismus after scleral buckling: multiple mechanisms revealed by high-resolution magnetic resonance imaging. Ophthalmology 2005;112:327–336.

11. Fison PN, Chignell AH. Diplopia after retinal detachment surgery. Br J Ophthalmol 1987;71:521–525.

12. Rabinowitz R, Velez FG, Pineles SL. Risk factors influencing the outcome of strabismus surgery following retinal detachment surgery with scleral buckle. J AAPOS 2013;17:594–597.

13. Goezinne F, Berendschot TTJM, van Daal EWM, Janssen LCH, Liem ATA, Lundqvist IJ, et al. Diplopia was not predictable and not associated with buckle position after scleral buckling surgery for retinal detachment. Retina 2012;32:1514–1524.

14. Kasbekar SA, Wong V, Young J, Stappler T, Durnian JM. Strabismus following retinal detachment repair: a comparison between scleral buckling and vitrectomy procedures. Eye 2011;25:1202–1206.