Simulated Surgery: Retinal Buckling: Placing the Sutures for a Scleral Buckle

The SOS Advanced retinal Buckling eye has been designed to simulate both retinal buckling and encircling band surgery. This video demonstrates how to accurately and securely pre-place the 5/0 Ethibond sutures at the site of the retinal break, before inserting the buckle. The life-like conjunctiva, sclera and rectus muscles help recreate the tactile experience of live surgery.

In addition to Cybersight, you can find videos featuring teaching techniques for all types of ocular surgery, using any form of simulation, in the Simulation Gallery.


In this video, we share how to place the sutures that will hold the scleral buckle, initially measuring with a caliper, 9 millimeters back from the muscle insertion. This is for a 7 millimeter buckle. The sutures have to be 9 millimeters apart, so that there is 1 millimeter on either side of the buckle, which will allow the indent to occur when the buckle is tightened. So a marker pen is used to mark the sclera. The sclera needs to be dried first with a swab, and then the marker pen will be taken up. A posterior suture is placed in the circumferential manner. And these model eyes have got a resistance to the pass of the needle which is very similar to a real sclera. The suture should not be placed too deeply, due to the risk of damaging the choroid. But obviously too shallowly will not give the required strength. The anterior suture is placed in a mattress fashion, and orientated radially towards the center of the cornea. This anterior suture is placed through the scleral ring, where the sclera is slightly thicker at the muscle insertions. This allows a strong anchorage point. The anterior suture is actually more important in terms of the location of the buckle, in some respects, because it actually prevents anterior migration of the buckle. So once the sutures are placed, a bulldog clip can be temporarily put onto the sutures. So in a buckle, per segment, we probably need two sutures per segment of the buckle. Although additional sutures can be placed if the shape of the buckle isn’t even. If it’s not producing an even indent. The Scephens retractor is moved further over to improve the exposure. The eye can be rotated a little further by grasping the muscle at its insertion, which is a firm anchorage point. The length of the suture track shouldn’t be too long. This is mainly because it can cause circumferential contraction of the sclera, if it’s too long. Once again, the suture is lined up so it’s radial with the center of the cornea. Both on the forward pass and the reverse pass. Exposure is vital during this procedure. So once again, this is a good simulation for both the surgeon and the assistant. Creating adequate exposure without actually interfering with the view for the surgeon is a real art in itself.

Last Updated: October 31, 2022

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