Retinal detachment is a serious condition that causes rapid loss of vision without treatment.
Retinal detachment occurs when the retina separates from the back wall of the eye. This happens most commonly when the vitreous gel pulls on the retina causing a retinal tear or hole. The opening through the tear or hole allows liquefied vitreous gel, which is mostly water, to go through the tear and enter the space underneath the retina. This sub retinal fluid builds up quickly causing the retina to fall away (like wallpaper coming down from a wall).
At first, patients may only experience sudden onset of floaters or flashes of light. When a "curtain" like shadow or area of missing vision in the periphery occurs, this indicates a retinal detachment progressing.
It is important to try to catch the retinal detachment before the central retina (the macula) becomes detached or "off" and have it repaired for the best chances to restore the vision.
There are several different surgical methods, each having some advantages and disadvantages as well as risks. These include pneumatic retinopexy, scleral buckle, pars plana vitrectomy, a combined scleral buckle and vitrectomy procedure, tamponade agents such as gas bubble or silicone oil. Your retinal surgeon and specialist will determine, based on the examination and diagnostic testing, which surgical technique is advisable, as there are many factors that go into consideration when making a decision.
Vitrectomy surgery for repair of retinal detachment
Vitrectomy is the most common surgery performed currently to repair a retinal detachment. However, there are several criteria used by the surgeon to determine whether this is the right or best technique compared to other methods discussed below. The principle mechanism by which this surgery re attaches the retina is by removing the vitreous gel (vitrectomy) that pulls on the retina, causing traction, which results in a retinal tear and detachment. Once the retina attaches during surgery, laser is used to create adhesion, and a gas bubble or silicone oil to keep the retina attached. The gas bubble causes the vision to be very blurry while it remains in the eye before it dissipates on its own, which can vary from 2 weeks to 6 weeks, depending on the type of gas used. Silicone oil is used in some cases, and patients can see through the oil, but it needs to be removed at a later operation.
The disadvantage of the procedure is that the vitrectomy in older patients, it will cause a cataract to develop more rapidly than it would naturally. In younger patients, the cataract development is slower. However, as the vitreous gel is firmer in younger patients, there are considerations where a scleral buckle technique may be more beneficial than a vitrectomy.
Scleral buckle surgery for retinal detachment
Scleral buckle is a technique that utilizes placing a medical grade silicone sponge or element on the outside wall of the eye (the sclera). The buckle causes an indentation of the wall of the eye over the retinal tear, resulting in helping to re attach the retina. The scleral buckle and the sutures used to secure it remain as a permanent device and has been used since the 1950's and the techniques and materials improved since then. As it does not contain any metallic material, it is safe to have MRI and also walk through metal detectors after the surgery. Scleral buckle can remain permanently and typically is not necessary to remove it as it is not visible under th layers of the eye and behind the eyelids.
Combined vitrectomy and scleral buckle surgery for repair of retinal detachment
In complex retinal detachments, the surgeon will determine, based on several findings and factors, that a combined scleral buckle and vitrectomy surgery is necessary. This combined procedure can help to maximize the chances of successful re attachment of the retina.
Pneumatic retinopexy surgery for repair of retinal detachment
In select cases of types of retinal detachment, an in office and less invasive surgery called pneumatic retinopexy can be done. The keys to success include localized retinal detachment in a small area confined to retinal tear in the upper areas of the retina, as well as the ability of the patient to remain seated and keeping the head tilted in a specific position over 24 hours. The advantage of this procedure is that it less invasive than a scleral buckle or vitrectomy surgery. The disadvantages are that it is limited to certain types of retinal detachments, patient ability to maintain special head positioning, and success rate slightly lower than scleral buckle or vitrectomy. Your retina specialist will determine whether you are a candidate for this procedure or whether the other techniques are better suited for repair.