Retinal Detachment Surgery is the only treatment for retinal detachment and consists of reattaching the retina to prevent or reverse vision loss.
The retina is the light responsive tissue that lines the back of the eye. Rays of light focus onto the retina through the cornea, pupil, and lens. Then, the retina transfigures the light rays into impulses that move through the optic nerve to the brain, where they are comprehended as the images we see. Simply put, the retina transports images through the optic nerve to the brain and consists of millions of cells that detect light like a camera. A healthy retina is necessary for clear vision.
What is Retinal Detachment Repair Surgery?
Retinal detachment repair surgery is an operation to reposition a detached retina in its correct location within the eye. A detached retina is defined as the separation of the tissue lining the back of the eye from its supporting layers of blood vessels, which supply the retina with nourishment and oxygen. Usually retinal detachment is an emergency situation and occurs when there is a reduction or contraction of the vitreous fluid (gel-like material) that occupies the inside of the eye. This can cause a pulling on the retina and a retinal tear that results in retinal detachment. If a person experiences “floaters” (objects seeming to flat across the eye) or sees a grey veil advancing across their field of vision, these could be signs of retinal detachment. If experiencing these symptoms, a person must act quickly and acquire emergency medical attention. Ultimately, retinal detachment surgery restores circulation to the retina and sustains vision.
Why have Retinal Detachment Repair Surgery?
Surgery is almost invariably used to fix a retinal tear, hole, or detachment. Retinal detachments do not improve without treatment, leave the retinal cells without oxygen, and the more time a detached retina goes untreated, the larger the risk for permanent vision loss in the damaged eye becomes. When the retina pulls away from the back of the eye and its blood supply, the retinal cells will begin to die, resulting in lasting vision impairment. If the macula (central vision area) particularly loosens, it is likely that vision will be permanently damaged, and if the macula completely detaches, vision may be fully lost. Luckily, early diagnosis and treatment can usually save vision. To preempt these very detrimental and serious complications, contact an eye specialist (opthalmologist) immediately upon experiencing any of the above-mentioned warning signs.
A person may have an increased risk for retinal detachment if they have experienced severe trauma to the eye, glaucoma, nearsightedness, have undergone cataract surgery, have experienced previous retinal detachment in the other eye, or have a family history of retinal detachment.
Risks and Complications of Retinal Detachment Repair Surgery
- High pressure inside the eye (glaucoma).
- Bleeding in the eye.
- Clouding of the lens (cataract).
- Requirement of additional surgery.
If injury to the retina occurred prior to reattachment, permanent vision loss may result.
What to Expect Before Retinal Detachment Repair Surgery
Since retinal detachment surgery is usually performed on an emergency basis, it is difficult to advise a person on ways to prepare for this procedure.
The patient should make sure to inform their doctor of any medications they have been taking, because medications can interfere with surgery and anesthesia.
Retinal repair surgery is typically an outpatient procedure, so it does not require an overnight stay in the hospital or surgery center. The patient, however, will not be able to drive home after the procedure, so it is best for someone to accompany them to the hospital.
What to Expect During Retinal Detachment Repair Surgery
There are multiple procedures used for retinal detachment surgery, and which method is used depends on the location, severity, and cause of the detachment. Procedures to reattach the retina include:
- Pneumatic retinopexy (gas bubble placement): If the retina has just begun detaching, a procedure called pneumatic retinopexy (gas bubble placement) may be performed. This procedure is usually done in the eye doctor’s office. The opthalmologist injects the eye with a bubble of gas, and the patient is oriented so the bubble will float up against the hole in the retina and force it back into its correct place. The surgeon then closes the hole permanently with a laser. Following the surgery, the gas bubble dissolves.
- Scleral buckle method: The procedure is used for serious cases of retinal detachment and can be done under local anesthesia (area is numbed) or general anesthesia (patient is asleep for the procedure). During the scleral buckle method of retinal reattachment, the surgeon makes an indention in the wall of the eye so that it converges with the hole in the retina. This is accomplished through putting a flexible band around the eye to impede the force that is moving the retina out of place. The fluid behind the detached retina is removed, and the retina should return to its correct place.
- Vitrectomy: Usually this procedure is performed under general anesthesia (patient is asleep for procedure). For a vitrectomy procedure, the surgeon frees tension in the retina by using very small instruments inside of the eye. This enables the retina to move back to its correct position. Patients undergo this type of retinal reattachment for serious cases of retinal detachment. A vitrectomy may necessitate the partial withdrawal of vitreous fluid from the eye.
For very involved cases, some retinal detachment surgeries will require both the scleral buckle method procedure and a vitrectomy.
What to Expect After Retinal Detachment Repair Surgery
If the retina was reattached by the ‘gas bubble procedure,’ it will be necessary for the patient to keep their head in a position facing down or to the side for multiple days or even several weeks. Maintaining this position is crucial in order for the gas bubble to press the retina back into its correct location. These patients cannot fly or go to high altitudes before the gas bubble dissolves, which usually takes a few weeks.
After retinal detachment surgery, overall healing and ascertaining how much vision will actually be restored may take several months.
Outcome of Retinal Detachment Repair Surgery
The prospect of successful retinal reattachment is contingent upon the number of holes, their size, and if scar tissue exists in the area. Typically, a retina can be reattached after just one surgery, but some people require multiple surgeries. Over 90% of detachments can successfully be repaired, but failure to repair the retina, unfortunately, consistently results in poor or no vision in the affected eye.
Following the operation, the level of vision typically depends on the location of the original detachment and the cause of the detachment. If the macula (central area of the eye) was not involved in the retinal injury, vision after reattachment will normally be very good. If the macula was compromised for under a week, vision is usually improved but not restored to 20/20 (normal). If the macula was detached for a significant amount of time, a small amount of vision will be restored but it will be severely impaired. Usually, if this is the case, vision will only be restored to less than 20/200, which is the limit for legal blindness.