Is it safe to perform a Magnetic Resonance Imaging (MRI) scan on a patient with a scleral buckle?

MRI Safety with Scleral Buckles

Modern scleral buckles are non-ferromagnetic and MRI-compatible, making MRI imaging both safe and clinically useful in patients with these devices. 1

Safety Profile

• All contemporary scleral buckle materials are MRI-safe and do not pose ferromagnetic risks during magnetic resonance imaging 1
• The American Academy of Ophthalmology explicitly supports the use of high-resolution MRI for evaluating patients with scleral buckles 1
• MRI can be performed without concern for device displacement, heating, or artifact that would compromise patient safety 1

Clinical Utility of MRI in Scleral Buckle Patients

MRI is particularly valuable when complications develop after buckling surgery, providing superior soft tissue detail that other imaging modalities cannot match:

Diagnostic Applications

• Strabismus evaluation: High-resolution MRI is the gold standard for identifying the mechanisms of post-buckle strabismus, including extraocular muscle disinsertion, anterior migration of buckle elements, and mass effect from the buckle itself 2
• Muscle pathology detection: MRI readily demonstrates extraocular muscle size, contractility, and relationship to the buckle and sclera 2
• Surgical planning: Preoperative orbital MRI helps distinguish multiple mechanisms of persistent severe strabismus and guides surgical approach, including whether transconjunctival surgery versus orbitotomy is needed 2

Specific Findings MRI Can Identify

• Extraocular muscle disinsertion from the globe at the buckle site 2
• Anterior migration and transection of rectus muscles by silicone elements 2
• Location and contractile potential of disinserted muscles, even years after the initial surgery 2
• Buckle displacement and relationship to surrounding structures 3, 2

When to Order MRI

Consider MRI in the following clinical scenarios:

• Development of new-onset strabismus after scleral buckle surgery, particularly large-angle deviations (≥25 prism diopters) 2
• Persistent diplopia with restricted ocular motility 2
• Suspected heavy eye syndrome in myopic patients with prior buckle surgery 3
• Evaluation of chronic complications when detailed soft tissue assessment is needed 3, 2

Imaging Protocol Considerations

• Multipositional high-resolution MRI using surface coils in multiple controlled gaze positions provides optimal visualization 2
• Coronal, sagittal, and axial images should be obtained as clinically appropriate 2
• MRI demonstrates increased signal intensity in preseptal regions when infection is present 4

Alternative Imaging When MRI Is Contraindicated

If MRI cannot be performed (pacemakers, certain metallic implants, severe claustrophobia):

• CT scanning is the alternative for evaluating buckle position and complications 4, 5
• CT can identify scleral thickening, buckle displacement, and soft tissue changes associated with infection 4
• CT is particularly useful for detecting anterior slippage of silicone bands and dehiscence of scleral belt loop tunnels 5

Common Pitfalls to Avoid

• Do not assume older buckles are ferromagnetic: Even buckles placed decades ago are typically MRI-compatible, as non-ferromagnetic materials have been standard for many years 1
• Do not rely solely on clinical examination for post-buckle strabismus: MRI frequently reveals unexpected findings such as muscle disinsertion that are not apparent on examination alone 2
• Do not delay imaging when complications arise: Early MRI diagnosis allows for timely surgical intervention, which can successfully restore alignment even years after muscle disinsertion 2