Retinal Detachment Repair
The retina, which lines the inside of the posterior wall of the eye, may occasionally become detached for various reasons. Most commonly, retinal detachment occurs as a result of a tear or hole in the retina, which develops as a result of a posterior vitreous detachment or separation (PVD). The retinal tear or hole allows fluid to enter the subretinal space, thus detaching the retina.
The retina receives oxygen and nutrients from the underlying choroid (vascular layer) of the eye. When a retinal detachment occurs, the detached retina begins to dysfunction, and ultimately, necrosis (death) ensues as a result if the retina is not reattached to the underlying choroid. As such, a retinal detachment is an urgent condition. The detached retina should be recognized and treated promptly.
- Rhegmatogenous retinal detachment (secondary to retinal hole or tear)
- Tractional retinal detachment (secondary to vitreous membranes, such as that which may occur in proliferative diabetic retinopathy)
- Proliferative vitreoretinopathy (PVR), secondary to long-standing retinal detachment
The surgical management of retinal detachment may include several different procedures, depending on the circumstances. These procedures include pneumatic retinopexy, scleral buckling, and vitrectomy. Each of these procedures is discussed below.
Pneumatic Retinopexy
Pneumatic retinopexy is a procedure in which a gas bubble is placed inside the vitreous cavity, either before or after, the retinal hole is treated with laser or cryotherapy (freezing) to help seal the hole permanently. The gas bubble, which must be positioned over the hole, prevents fluid from entering the hole while the retina heals. Ophthalmologists sometimes use the phrase, "put the bubble on the trouble" to describe this aspect of the procedure to patients. Since the positioning of the bubble is dependent on positioning of the patient, pneumatic retinopexy is usually only appropriate for retinal detachments (with holes) in the superior (top) part of the eye.
Scleral Buckling
Scleral buckling surgery is probably the most commonly required procedure for repair of retinal detachment. In this procedure, a soft silicone band is placed around the eye, which indents the outside of the eye towards the detached retina, thereby relieving vitreous traction on the retinal hole. The buckle is much like a belt around one's waist. It is kept in place with tiny sutures to the sclera of the eye. In many cases, the vitreo-retinal surgeon drains the fluid under the retina at the site of the retinal detachment, and then seals the hole (or holes) with laser or cryotherapy.
Vitrectomy
In some cases, a vitrectomy is also necessary for repair of a retinal detachment. In this procedure, the vitreous humor is removed from the eye with an instrument known as a vitrector. This instrument utilizes a tiny guillotine cutting device to safely remove the vitreous while replacing it with saline. Laser photocoagulation or cryotherapy are still typically used if a retinal hole or tear is present. A scleral buckling procedure may also be combined with the vitrectomy for certain types of retinal detachment.
Retinal detachment can be successfully repaired in about 90% of cases with a single surgical procedure. However, anatomical success does not always mean functional success. Those patients with retinal detachments that do not involve the macula (central retina) have the best prognosis. Fortunately, the great majority of patients will have a successful outcome, especially if they seek attention as soon as vision is lost.
Following retinal detachment surgery, you will likely be required to use antibiotic and anti-inflammatory eye drop medications, perhaps for a few weeks or more following surgery. Your surgeon will prescribe a regimen of medication and follow-up, which you should carefully follow.
Recovery following retinal detachment repair will depend largely on the location and extent of retinal detachment prior to repair. Patients who have had only a peripheral retinal detachment will likely have faster recovery and a better outcome than patients who had a retinal detachment involving the macula (central retina). Patients who had a total retinal detachment, which had been present for a few weeks or more, have a much worse prognosis for a favorable visual result. In any case, the final visual result may not be known for up to several months following surgery. Your surgeon will be the best judge of what individual results you should expect.
