RETINAL DETACHMENT SURGERY

Retinal detachment surgery involves reattaching the retina to the back of the eye and sealing any breaks or holes. A retinal tear may be accompanied by the sensation of flashing lights in the affected eye. If there is bleeding into the vitreous gel, there may also be showers of dark ‘floaters’ and blurred vision. As the retina detaches it often causes a dark shadow – like a curtain or veil – in the peripheral vision, which usually progresses to complete vision loss. A retinal detachment needs prompt corrective surgery to prevent permanent damage to your eyesight.

What is Retinal Detachment?

Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness.

Retina is a thin layer of light-sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.

Operative procedures

There are various methods available to reattach the retina, including:
• Pneumatic retinoplexy
This is the simplest procedure for repair of a detachment, but is not suitable for all cases. The retinal surgeon injects a gas bubble into the vitreous cavity and treats the tear(s) with either laser or cryotherapy (freezing). The bubble presses the retina flat against the wall of the eye and the laser or freezing sticks the retina down. In order for this to happen, it is important to follow the surgeon’s instructions about keeping your head in the correct position after the surgery. The gas gradually disappears over the days or weeks following the surgery.
• Scleral buckling
The retinal tear is treated with cryotherapy. The fluid under the retina is drained and a specially shaped piece of silicone rubber is sutured to the outer wall of the eye (the sclera). The silicone creates an indent, which closes the tear and holds it in place while the cryotherapy seal has time to form. The scleral buckle is permanent.
• Vitrectomy surgery
Under an operating microscope, the vitreous is surgically removed using very fine instruments. Any tears are treated with laser or cryotherapy and the eye is filled with gas or silicone oil. It is important to follow instructions about post-operative head positioning to allow the retina to stick down. You will experience temporary poor vision while your eye is filled with gas. However, if the surgery is successful your vision will improve as the gas reabsorbs and is replaced with the eye’s own clear fluid. If silicone oil has been used, you will still be able to see, although the image will tend to be out of focus. Silicone oil is usually removed after a few months; occasionally, however, the retinal surgeon may decide to leave it in the eye indefinitely.

How long do I have to be hospitalized?

You may need to stay in hospital overnight or, occasionally, longer. Immediately after the operation your eye will be covered with an eye pad and perhaps a protective eye shield.

Recovery & Recuperation

Your eye may be sore for several weeks and your vision will be blurry for several weeks. It may take up anywhere from three to six months for your vision to improve. It is normal to experience a ‘gritty’ feeling on the surface of your eye – this is caused by the tiny stitches and for it to water. Avoid rubbing or pressing on the eye. You may need to wear an eye pad for protection at night while your eye is healing and follow all instructions on head positioning. Make sure to follow all directions for medications, such as eye drops and avoid vigorous activity for some weeks following surgery.

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