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Retinal detachment repair

Definition

Retinal detachment repair is eye surgery to place a detached retina back into its normal position.

A detached retina means the light-sensitive tissue in the back of the eye has separated from its supporting layers.

This article describes the repair of rhegmatogenous retinal detachments -- retinal detachments that occur due to a hole or tear in the retina.

Alternative Names

Scleral buckling; Vitrectomy; Pneumatic retinopexy; Laser retinopexy

Description

Most retinal detachment repair operations are urgent. A detached retina lacks oxygen, which causes cells in the area to die. This can lead to blindness.

If holes or tears in the retina are found before a detachment occurs, an ophthalmologist can close the holes using a laser. This is usually done in the doctor's office.

If the retina has just started to detach, a procedure called pneumatic retinopexy may be done to repair it.

• Pneumatic retinopexy (gas bubble placement) is usually an office procedure. The eye doctor injects a bubble of gas into the eye.
• You are then positioned so the gas bubble floats up against the hole in the retina and pushes it back into place.
• The doctor will use a laser to permanently seal the hole.

Severe detachments need more advanced surgery. The following procedures are done in a hospital or outpatient surgery center:

• The scleral buckle method indents the wall of the eye inward so that it meets the hole in the retina. Scleral buckling can be done under local or general anesthesia.
• The vitrectomy procedure uses very small instruments inside the eye to release tension on the retina, allowing it to move back into proper position. Most vitrectomies are done under local anesthesia.

For some complex detachments, both procedures may be done during the same operation.

Why the Procedure Is Performed

Retinal detachments do not improve without treatment. Repair is needed to prevent permanent vision loss.

The urgency of the surgery depends on the location and extent of the detachment. If the detachment has not affected the central vision area (the macula), surgery should be done quickly, usually the same day. This is necessary to prevent further detachment of the retina and to increase the chance of preserving good vision.

If the macula detaches, the surgery can still be done to prevent total blindness, but the vision will not be as good. If the macula has already detached, it is already too late. Eye doctors can wait a week to 10 days to schedule surgery.

Risks

Risks for retinal detachment surgery include:

• Bleeding
• Detachment that is not completely fixed (may require more surgeries)
• Increase in eye pressure (elevated intraocular pressure)
• Infection

General anesthesia may be needed. The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

After the Procedure

The chances of successful reattachment of the retina depend on the number of holes, their size, and whether there is scar tissue in the area.

Most of the time, the retina can be reattached with only one operation, although some people need several surgeries. Less than 10% of detachments cannot be repaired. Failure to repair the retina always leads to poor or no vision in the eye.

After surgery, the quality of vision depends on where the detachment occurred, and the cause:

• If the central area of vision (macula) was not involved, vision will usually be very good.
• If the macula was involved for less than 1 week, vision will usually be improved, but not to 20/20 (normal).
• If the macula was detached for a long time, some vision will return, but it will be very impaired. Often, it will be less than 20/200, the limit for legal blindness.

Outlook (Prognosis)

The procedures usually do not require an overnight hospital stay.

You may need to limit physical activity for some time.

If the retina is repaired using the gas bubble procedure, you need to keep your head face down or turned to one side for several days or weeks. It is important to maintain this position so the gas bubble pushes the retina into place.

Patients with a gas bubble in the eye may not fly or go to high altitudes until the gas bubble dissolves. This usually happens within a few weeks.

References

Connolly BP, Regillo CD. Rhegmatogenous retinal detachment. In: Tansman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 27.

Williams GA, Aaberg TM Jr. Techniques of scleral buckling. In: Tansman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 59.