The repair of a detached retina in the eye. The retina is a thin sheet of light-sensitive nerve tissue that lines the inside of the eye. The sensory layer of the retina, which receives images and transmits them to the brain, can be pulled away (detached) from its normal position in the back wall of the eye, resulting in vision loss.
PARTS OF THE BODY INVOLVED
Eye
REASONS FOR PROCEDURE
To repair the retina. If retinal detachment is not repaired within 24 - 72 hours, permanent damage is likely to occur.
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
Presence of nuclear sclerotic cataracts (yellowing of the center of the lens), which can worsen after vitreous surgery
WHAT TO EXPECT
Prior to Procedure
Your doctor will likely do some or all of the following:
Blood and urine tests
- Fluorescein – a test that involves injecting dye into the bloodstream and taking photographs with ultraviolet light
- CT scan – a type of x-ray that uses a computer to make pictures of the inside of the body
- MRI scan – a test that uses magnetic waves to make pictures of the inside of the body
- Chest x-ray - a test that uses radiation to take a picture of structures inside the body
During Procedure – Anesthesia
Anesthesia – Local or general, depending on the type of procedure done
Description of the Procedure - There are several surgical options to repair retinal detachment. The most common are:
Scleral buckle – A flexible silicone rubber band is permanently stitched to the outside surface of the back half of the eye. This band acts like a belt that "buckles" the area containing the retinal tear or detachment to the wall of the eye. Since the buckle is behind the cornea, it is not visible. This procedure has a 90% success rate in re-attaching the retina. Local or general anesthesia is used.
Pneumatic Retinopexy –A gas bubble is injected into thevitreous cavity of the eye, which forces the retina outward against the sclera (white part of the eye.) You may need to lie in a special position to keep the gas bubble in place. The retina usually re-attaches within several days, and then is sealed back into place against the wall of the eye with laser photocoagulation or cryotherapy. Laser photocoagulation uses heat, in the form of laser light, and cryotherapy uses extreme cold to seal the retina.
This treatment method generally has a 75% success rate; however, it is not suitable for all types of detachment. Local anesthesia is used.
Vitrectomy (removal of the vitreous humor) – This procedure may be required for more complicated retinal detachments, or if the procedures described above are not successful. This procedure removes the vitreous jelly as well as any scar tissue, and replaces it with a gas bubble. This gas bubble will push the retina back against the eye wall. Then, Laser photocoagulation or cryotherapy is used to seal retinal breaks. Laser photocoagulation uses heat, in the form of laser light, and cryotherapy uses extreme cold to seal the retina. Local anesthesia is used.
After Procedure – Your eye will be covered with a bandage and metal shield for one day after the surgery
How Long Will It Take? 1–4 hours, depending on which procedure is done
Will It Hurt? Anesthesia prevents pain during the procedure. During recovery, you may experience some pain or nausea, but your doctor can give you pain medication to relieve this discomfort.
Possible Complications:
- Proliferative vitreoretinopathy – In rare cases, this condition causes progressive contraction and scarring of the retina after retinal detachment repair, and may necessitate additional surgery
Average Hospital Stay: 0 – 2 days
Postoperative Care:
- Do not allow your eye to come into contact with running water
- Avoid physical activity for a few days after surgery
- Schedule follow-up appointments with your doctor to monitor your recovery and to determine if you will need a change in your eyeglass or contact lens prescription
OUTCOME
The outcome of this procedure depends on several factors, including your vision before the surgery, and the location and extent of detachment. If your vision was good prior to the procedure, a successful operation should restore vision to good levels. However, if vision was poor prior to surgery, final visual return may be slow and remain incomplete after surgery. In addition, a peripheral retinal detachment will likely heal quicker than one that involves the macula (central retina), or total detachment.
In any case, the final visual result may not be known for several months after surgery.
You can expect to return to work within 1-2 weeks after surgery.
CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS
- Any change in vision
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the surgical site
SOURCES:
Digital Journal of Ophthalmology, Harvard University
Charles Retina Institute
The Schepens Eye Research Institute
