MRI Safety with Scleral Buckles
MRI imaging is safe and clinically useful in patients with scleral buckles, as modern scleral buckle materials (silicone sponges, silicone bands, and solid silicone elements) are non-ferromagnetic and MRI-compatible. 1
Clinical Evidence Supporting MRI Use
High-resolution MRI is explicitly recommended by the American Academy of Ophthalmology for evaluating patients with scleral buckles, particularly when strabismus or other complications develop after buckling surgery. 1
Diagnostic Applications
MRI provides valuable diagnostic information about the mechanism of post-buckle strabismus, revealing multiple pathologic processes including extraocular muscle disinsertion, muscle transection by buckle elements, restrictive strabismus from buckle mass effect, and muscle scarring. 2
Multipositional high-resolution MRI demonstrates extraocular muscle size, contractility, location of disinserted muscles, and the relationship between muscles and buckle hardware, which is critical for surgical planning. 2
MRI successfully identifies scleral buckle infections, showing increased signal intensity in preseptal regions and scleral thickening around infected buckles. 3
MRI confirms diagnoses of heavy eye syndrome in patients with prior scleral buckle surgery, allowing tailored surgical interventions. 4
Proton magnetic resonance spectroscopy can distinguish between orbital abscess and liquefied hydrogel buckle material, preventing unnecessary surgical interventions. 5
Material Compatibility
Silicone sponge buckles demonstrate low attenuation on CT without infection and high attenuation with infection, but are non-ferromagnetic and safe for MRI. 3
All modern scleral buckle materials used in current practice are MRI-compatible, as evidenced by multiple published cases of successful MRI imaging in buckled patients without adverse events. 3, 4, 2, 5
Clinical Recommendations
Obtain high-resolution MRI when evaluating persistent strabismus after scleral buckling, particularly for deviations present for months to years that may indicate muscle disinsertion or other mechanical complications. 2
Use multipositional MRI with surface coils in multiple controlled gaze positions to fully assess extraocular muscle pathology and buckle-related complications. 2
Consider MRI for any suspected post-buckle complications including infection, orbital inflammation, or unexplained symptoms, as imaging provides diagnostic clarity that guides management. 3, 5
Important Caveats
Historical scleral buckles placed before the 1980s may have contained ferromagnetic materials (such as certain metal clips or wires), requiring verification of buckle composition before MRI if the surgical record is available. However, this is exceedingly rare in modern practice.
The presence of a scleral buckle does not contraindicate MRI, but radiologists should be informed of the buckle's presence to optimize imaging protocols and interpret findings correctly. 3, 4, 2