Minimizing Risk in Scleral Buckle Surgery: A Novel Approach to Belt Loop Creation Using a Guarded Diamond Blade

Purpose: To describe a novel technique for scleral belt loop formation during scleral buckle (SB) surgery using a guarded diamond limbal relaxing incision (LRI) blade to minimize the risk of scleral perforation and improve groove consistency. Methods: A conventional scleral buckle procedure was performed for rhegmatogenous retinal detachment (RRD) with the placement of a #240 encircling band. Four partial-thickness scleral grooves were created in each quadrant using a guarded diamond LRI blade with a preset depth of 150 µm. The band was passed through the resulting belt loops and secured with a Watzke sleeve. Operative efficiency, tissue resistance, and groove quality were assessed intraoperatively. Results: The guarded diamond blade enabled single-pass formation of uniform scleral grooves with minimal resistance and excellent visualization. No intraoperative complications were observed, including scleral perforation, hypotony, or hemorrhage. Groove creation was rapid and reproducible. Conclusion: Use of a guarded diamond LRI blade for scleral belt loop creation provides a precise, efficient, and low-risk alternative to traditional dissection techniques. This approach may improve surgical safety and efficiency.