If the retina has become detached and the detachment is too large for laser treatment or cryotherapy alone, surgery is necessary to "reattach" the retina. Without some type of retinal reattachment surgery, vision will almost always be completely lost. There are three types of surgery for retinal detachment: 1) scleral bucking surgery, 2) pneumatic retinopexy, and 3) vitrectomy.
The traditional surgery for retinal detachment is scleral buckling surgery. This surgery is generally performed in the operating room under local anesthesia but, in some cases, may be performed under general anesthesia. The surgeon first treats the retinal tear with cryotherapy. A cryoprobe is placed on the outside part of the eye (the sclera) as the surgeon looks into the eye. The surgeon then places the cryoprobe in the correct position and the retinal tear is treated. A piece of silicone plastic or sponge is then sewn onto the outside wall of the eye (sclera) over the site of the retinal tear. This pushes the sclera in toward the retinal tear and holds the retina against the sclera until scarring from the cryotherapy seals the tear. This surgery is called scleral buckling because the sclera is buckled (pushed) in by the silicone. This silicone buckle is left on the eye permanently.