This is a beautiful Optos image of bilateral scleral buckles in a 51YO female myopic patient who underwent successful retinal reattachment surgery years ago.
Learning Points:
The normal neurosensory retina remains attached to the RPE due to numerous physiologic mechanisms, including the inner and outer blood-retinal barriers, the hyperosmotic choroid passively drawing fluid into the subretinal space, the RPE pump, the interphotoreceptor matrix, and friction between the RPE microvilli and the photoreceptor outer segments.
Rhegmatogenous retinal detachment (RRD) occurs when liquid vitreous, entering the subretinal space through a retinal break, overwhelms these forces, favoring retinal detachment.
Repairing RRD involves finding and closing all breaks, essentially denying the liquid vitreous access to the subretinal space. The break(s) can be closed internally with a gas bubble via pneumatic retinopexy or vitrectomy surgery, or externally by securing a piece of silicone material to the sclera (scleral buckle). This indents, or buckles, the RPE against the retinal break.
