Retinal detachment repair is a general term referring to a type of eye surgery that fixes retinal detachment. Retinal detachment is a serious condition where retinal cells separate from blood vessels that give it nutrition and oxygen. Without oxygen, retinal cells start to die. It can also occur when vitreous retracts, pulling the retina and tearing it away.
The retina is a fine layer of photosensitive tissues found in the posterior eye. It receives light waves and sends them to the brain for visual recognition. The surgery puts back the retina into its regular position and restores blood circulation to the area, therefore, preserving vision. If retinal detachment remains untreated, the chance of permanent loss of vision increases.
Retinal detachment is diagnosed by conducting a retinal examination. During the test, the specialist uses a bright light to examine the posterior eye. It can also be diagnosed by doing an ultrasound in case bleeding has happened in the eye.
Retinal detachment signs may include:
- The sudden appearance of flashes of light
- The sudden appearance of floaters
- Grey veil or curtain-like shadow in the field of vision
- Reduced or blurry vision
- Reduced peripheral vision
Some causes and risk factors of retinal detachment include:
- Family history
- Severe eye injury/trauma to the eye
- Advanced age
- Previous cataract surgery
- Previous retinal detachment
- History of another eye disorder, such as retinoschisis or uveitis
There are three various forms of retinal detachment. They include:
- Rhegmatogenous – These are the most common types of retinal detachments. Here, fluid passes through the retina via a hole or a tear. The fluid collects at the retina's base, tugging at the retina, causing it to pull away. The most common cause is aging.
- Exudative – Here, fluid collects at the base of the retina. However, there is no retinal tear or hole
- Tractional – Here, scar tissue forms on top of the retina, making it move and become detached. It is most commonly seen in diabetic patients who have not controlled their condition.
There are three popular types of surgery conducted to fix a retinal detachment. They include:
- Pneumatic retinopexy
- Scleral buckle
If the patient is suffering from a retinal tear, the specialist could opt to perform:
- Photocoagulation (laser treatment)
- Cryopexy (freezing treatment)
The specialist decides what type of surgery (or a combination) to conduct based on the extent and location of the retina detachment.
Before the Procedure
The specialist will schedule surgery as soon as possible because the condition is a medical emergency.
Before the surgery, the specialist will note any medications, vitamins, and supplements that the patient is taking, including the doses. The specialist will also note the patient's medical history, including mental and physical. The patient is asked to heed to all the medical and dietary instructions the specialist will give them before the surgery. The patient should keep track of any symptoms they may be experiencing, even those that seem unrelated to the condition.
On the surgery day, the patient is asked to bring a friend or family member to take them home as they will experience blurry vision for a few hours.
To begin the procedure, the eye is cleaned, and a drape placed over the eye. Anesthesia and dilating drops are then administered. Because there are various surgeries done to repair different forms of detached retinas, varying levels of anesthesia and dilating drops are used.
- If the surgeon opts to perform a pneumatic retinopexy procedure – Local anesthesia and dilating eye drops will be used. The specialist injects an intraocular gas into the vitreous cavity. This bubble presses the retina against the eye's wall, ceasing the flow of vitreous into the area beyond the retina. The bubble, which is eventually absorbed into the body after a few days, pushes the retina into its usual place. Any fluid under the retina is absorbed, allowing the retina to attach firmly to the eye's wall.
- If the surgeon opts to perform a scleral buckling procedure – Local or general anesthesia is used, and because the surgery treats severe retinal detachment, it is done in a hospital or surgery center. During the operation, the surgeon sews a silicone material to the sclera, causing the walls of the eye to indent. This counteracts some of the force pulling the retina out of place.
If the eye has several holes or an extensive detachment, a flexible scleral buckle that goes around the patient's entire eye may be used. The buckle doesn't hinder vision and remains fixed.
- If the surgeon opts to perform a vitrectomy procedure – Here, the surgeon drains any substance like vitreous that may be tugging on the retina. S/he then injects air, silicone oil or gas into the vitreous space. This helps to flatten the retina. The injected material is eventually absorbed into the body, and the cavity will be replaced with natural body fluid. This procedure may be done together with a scleral buckling procedure.
- If the surgeon opts to perform a photocoagulation procedure – The surgeon uses a laser beam pointed through the pupil. The laser burns around the retinal tear, creating a scar that joins the retina to the surrounding tissue.
- If the surgeon opts to perform a cryopexy procedure – Local anesthesia is used, and the procedure is done in a surgical clinic. The surgeon places a freezing probe to the eye's outer surface, directly over the tear. Just like in photocoagulation, a scar is formed that joins the retina to the surrounding tissue.
Risks & Complications
Risks for retinal detachment surgery include but are not limited to:
- Elevated intraocular pressure
- Unsuccessful surgery
If the patient experiences any of the following, they should seek immediate medical care:
- Pus or discharge from the eye
- Vision changes
- New flashes of light
- New, severe and prolonged pain
Aftercare & Recovery
The patient will be required to use antibiotic eye drops for up to six weeks to minimize the possibility of an infection. They will also be required to wear sunglasses and an eye shield over the eye for a few days. The patient should also avoid getting any water or soap in the eye.
If the patient had a gas bubble injected, they must keep their head in a unique position for a few days to keep the bubble from moving. The doctor will give further instructions on how to do this. They are also required to avoid any air travel or sleeping on their back.
There are no dietary restrictions after the surgery. The patient may resume driving when their vision allows it. The patient shouldn't engage in any strenuous activities or moving quickly. The patient will fully recover after 2 to 4 weeks and can then resume work.
More than 90% of detachments can be fixed, and most of these cases can be repaired with just one operation. In the 10% that are incurable, the patient will experience no or poor vision in the affected eye.
The success of the procedure depends on the extent of the detachment and the scar tissue formed. It takes months to know how much vision will return.