Retinal detachment repair

Alternative names
Scleral buckling

Definition
This surgical procedure repairs a detached retina, which is a separation of the retina from its normal position lining the back of the eye.

Description

If you think of the eye as a camera, the retina is like the film in the camera. It lines the back inside surface of the eye, and converts the optical image into nerve impulses that travel via a large nerve to the brain, where the impules become vision. The retina is only held in place against the wall of the eye by the pressure of the gel and fluid that fills the eye. This is like an inner tube held to the wall of a tire by the pressure of air.

If a hole forms in the retina, the retina will deflate away from the wall of the eye, forming a retinal detachment. Holes in the retina occur for many reasons, but most are due to weak spots that occur for no identifiable reason. They are more common in nearsighted eyes. Detachments can also occur because of scar tissue pulling the retina forward, as often happens with diabetic Retinopathy.

Since the retina gets most of its blood supply from vessels in the wall of the eye, if it becomes detached, it does not get enough oxygen and cells in the retina suffer and begin to die. This is why most detachment repair operations are urgent.

A major symptom associated with a tear or detachment is seeing flashing lights similar to lightning flashes in front of your eyes. Also, a shade or curtain may appear to block your vision.

If holes in the retina are found before a detachment occurs, the holes can be sealed with a laser without invasive surgery. If detachment has recently started, repair may be possible with a procedure called pneumatic retinopexy. A gas bubble is injected into the eye and the patient is postioned so it floats up against the hole in the retina and pushes it back into place. Then a laser may be used to permanently seal it in place.

For detachments that are more advanced, a surgical procedure may be required. This may be done by bending the wall of the eye in to meet the hole in the retina (scleral buckle procedure) or using very small instruments inside the eye to remove a scar pulling the retina forward (vitrectomy procedure). For some complex detachments, both may be combined in the same operation.

Indications

Retinal detachments do not improve without treatment. Retinal detachment repair is necessary to prevent permanent vision loss.

The urgency of the surgery depends on the location of the detachment. If the detachment has not affected the central vision area called the macula, surgery should be done quickly, usually the same day. This is necessary to prevent more of the retina from peeling away.

If the macula detaches, the surgery can still be done, but the visual result will not be as good. If the macula has already detached, there is less urgency. Physicians can wait a week to 10 days to schedule surgery.

Risks
General anesthesia may be required. The risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

The risks for any surgery are:

     
  • bleeding  
  • infection

Expectations after surgery

The most important outcome for retinal detachment surgery is good vision. The chances of successfull re-attachment of the retina depends on how many holes there are in the retina, how large they are, and whether there is scar tissue on the retina pulling it forward.

Over 90% of retinal detachments can be re-attached, most with only one operation, but some requiring several. Less than 10% of detachments cannot be repaired. Failure to repair the detachment always results in poor or no vision in the eye.

Repaired detachments recover vision, but how sharp that vision will be depends on several factors. If the macula was never involved in the detachment, vision will usually be very sharp. If the macula was involved, but only for a short time (a week or less) the vision will usually be sharp, but not 20/20. If the macula was detached for a long time, vision will return, but it will not be sharp.

Convalescence

Retinal hole treatment with a laser can be done in an ophthalmologist’s office without a hospital stay. Pneumatic retinopexy is also usually an office procedure.

If the procedure requires scleral buckle or vitrectomy surgery, a hospital or outpatient surgery center is needed. Local anesthesia (injections to numb the eye and surrounding tissue) or general anesthesia may used, depending on the anticipated length of the operation. An overnight stay is not usually needed.

Activities will be limited for a period of time. For a detachment repair using a gas bubble, a certain head position may be required for a several weeks. The position may be face down or turned to one side. It is important to maintain this position to have the gas bubble push the retina in place. Patients with a gas bubble in the eye may not travel in aircraft, and must be certain to inform any other doctors who may treat them that a bubble is in their eye, particularly if other surgery is needed.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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