Surgery for treating retinal detachment

In one of these procedures, the surgeon sews a silicone tamponade onto the outside of the eyeball where the retinal tear is. That then indents the wall of the eyeball, pressing the retina back onto the layer below. They are then “glued” back together using a laser or cryoprobe.

Alternatively, a silicone strip (scleral buckle) is wrapped around the eyeball in a ring pattern. That indents it all the way around, and several holes in the retina can be closed with one procedure.

Over time, the fluid under the retina is reabsorbed by the surrounding tissue. Sometimes, it can be sucked away during the operation using a very thin probe.

Vision is still impaired for a while after the procedure. It takes about 30 to 90 minutes to perform the operation. It’s performed in hospital under general or local anesthetic.

When removing the vitreous body (vitrectomy), the surgeon inserts fine instruments into the eye, sucks the vitreous body up, and replaces it first with silicone oil or a special gas. That presses the retina and the layer below it back together. The surgeon then “glues” the layers to one another using laser or cryotherapy.

It might be important to keep your head in a certain position for a few days after surgery, depending on where the retina was detached. Your doctor will tell you what you need to know after the operation.

The gas is gradually transported away via the blood vessels and replaced by the body’s own fluid. Depending on which gas was used, that can take 2 weeks to 3 months. Vision is very restricted in the affected eye during that time.

If silicone oil is used, it is usually sucked up during another procedure. The eyeball fills up with the body’s own fluid again afterwards.

Which gas or oil is used depends on a number of factors such as how big the holes are or how quickly you need to be active again or if you have to travel: If the vitreous body is replaced with silicone oil, vision is temporarily still somewhat impaired. If gas is used, vision is severely impaired at first. You also can’t take any flights or spend time in the mountains for the first few weeks after the procedure if gas is used. That’s because the gas expands the higher up you are and the lower the air pressure is, which can damage the eye.

You also have to stay in the hospital for this procedure. It is performed using general or local anesthetic and takes about 30 to 90 minutes.

Your doctor will advise you about which procedure is best in your personal situation. A number of aspects are taken into account, such as

• The size, number and location of the holes in the retina: Scleral buckling procedures are better suited for one or just a few holes. On the other hand, vitreous body removal (vitrectomy) is more commonly used for if the holes are big or there are many of them. Vitrectomy can also be a better option if the middle of the retina is damaged near to or on the eye’s focal point ( macula).
• Medical history: If your eye has already been operated on and an artificial lens was fitted or there was bleeding, vitrectomy is probably a better option.
• The cause of the retinal detachment: Not all detached retinas are caused by tears. If it is caused by a build-up of fluid, vitrectomy is usually needed. If the retina has detached due to another disease such as a tumor, it’s important to also treat that.

The retina can be reattached during surgery in most people and they can see more clearly and with better contrast again. This is true for both procedures. But vision is often no longer as good as before the detached retina. How well you will be able to see after surgery depends on various factors such as the position, size and duration of the detached retina.

The retina detaches again in the same eye in the three years after the operation in about 20 to 30 out of 100 people. Another procedure is then necessary.

Complications that can impair vision can occur during or after surgery in either procedure. Treatment with medications or another procedure might be needed if that happens. But permanent effects can usually be avoided.

The most common complications are:

• Cataracts (early onset or worsening of cataracts)
• Growth and scarring of the retina (proliferative vitreoretinopathy)
• Fluid build-ups (edema) in the middle of the retina ( macula)
• Increased intraocular pressure

After scleral buckling it’s possible that you might see double for a while or have difficulties moving your eye, like when tracking an object. But these problems usually go away by themselves after a few weeks or months.

New holes can form in the retina during vitrectomy. They can usually be closed up again during the surgery.

In rare cases, serious complications such as infections, inflammations or bleeding can occur during both procedures.

Studies suggest that scleral buckling and vitrectomy are equally well suited for reattaching the retina and improving eyesight again. But they also find pointers that there are differences between some aspects of the procedures. For instance,

• the studies found that it was less common for the retina to become detached again following vitrectomy. And fewer operations were needed to treat the retinal damage.
• Different complications occurred: New tears in the retina only occurred during vitrectomy. Cataracts also developed more frequently after those operations.

But most of the studies only lasted a few months and looked at a small number of participants. That is why it isn’t yet possible to say whether one or other of the procedures is better.

You will usually stay in the hospital for a few days after surgery. Regular check-ups with an eye doctor are then needed to check things like eye pressure. It might be important to keep your head in a certain position for the first few days after the operation. Your doctor can give you more detailed information about that.

Doctors recommend eye drops or eye ointments to support the healing process. They can also prescribe painkillers if needed.

Your eye might be painful, swollen or red directly after surgery. Because it’s still sensitive, it’s important

• not to rub your eyes
• to make sure that no water, shampoo or dirt gets into the eye, and
• not to do any physical exertion such as jogging or lifting heavy weights, or go to the sauna or swimming pool for about two weeks.
• not to read or do any screen work for up to about two weeks to avoid the jolting movements when the eye moves from line to line. But it’s okay to watch television.

Your eyesight will be significantly worse for up to two weeks, especially if the eye was filled with gas after vitrectomy. That can affect your everyday life. You will only be able to drive again once your eye specialist has checked that your eyesight is good enough.