Surgery for retinal detachment

If you have a retinal detachment, your physician likely recommended a surgical procedure to repair it.  There are several options for repair of retinal detachment, and the one we recommend changes based on factors such as your age, whether you have had cataract surgery, the location of the retinal detachment, and if any scar tissue is already present in your eye.

A retinal detachment occurs when the layers of the retina separate from the choroid, or inner lining of the eye.  The goal of retinal detachment repair is to get the retina to "stick" to the back wall again.  This can be accomplished with several different options.

The first option is a pneumatic retinopexy.  This is an in office procedure where a gas bubble is placed in the eye.  The gas bubble pushes against the detached retina and holds it in place, allowing the retina to scar down.  The gas bubble is either preceded by cryo, which freezes around the tear causing the detachment, or followed later by laser, which seals around the tear that caused the detachment.  Only certain people are candidates for pneumatic retinopexy.  The tears causing the detachment must be close to one another, and must be near the top or the sides of the eye.  This is so the bubble, which floats, can press against the tear. Also, the patient must be able to hold a specific position for 5-7 days which can be difficult for the elderly and patients with neck or back problems. The gas bubble dissolves over time leaving the retina attached in about 70- 75 % of cases.

The second option for repair is a scleral buckle.  In a scleral buckle, the tear, or tears, are frozen with cryo, and a silicone band is placed around the eye and sutured in place. This is done in the operating room. The buckle stays in place for life in most cases.  A gas bubble may be used as well that will dissolve over a 3-6 week period.  Scleral buckles are excellent choices for young patients who have not yet had cataract surgery.

The third option for repair is a pars plana vitrectomy with oil or gas (the vitrectomy can be combined with a scleral buckle as well).  This is the most common procedure to repair a retinal detachment today and is also performed in the operating room.  In a pars plana vitrectomy, three small incisions are made in the eye.  The vitreous gel is removed and laser or cryo is used to seal around the causative holes or tears. A  gas bubble or oil bubble is then placed in the eye.  The gas bubble will dissolve over time (3-6 weeks).  The oil bubble will not dissolve and must be removed in the operating room at a later date.  In some cases, the oil may remain in for life. The decision between gas and oil is made by your surgeon depending on the type of retinal detachment you have and whether you have scar tissue that requires a long term solution like oil. As mentioned, in some cases, we do a scleral buckle and vitrectomy in the same procedure.

Each person's retinal detachment requires a thorough evaluation before the decision is made as to which surgery is appropriate.

This blog is for informational purposes only and is not medical advice. Please seek the advice of a qualified medical personnel.

Retinal tears

Retinal tears are a common diagnosis that we see in our practice.  Patients often wonder when they have flashes and floaters whether they have a retinal tear or detachment.  Many have researched these symptoms on the internet and see the words "retinal tear" and "retinal detachment" and, understandably, become concerned.

The retina is the inner lining of the back wall of the eye.  It is a 9 layered structure that "takes the picture" and sends it to the brain by way of the optic nerve.  The vitreous is a gel layer made up of collagen and other proteins as well as water that is between the lens, the focusing system of the eye, and the retina.  The vitreous is attached at the optic nerve, the macula, and the entire peripheral retina.  As we age, our vitreous becomes less gel-like and more liquid.  When this occurs, it begins to separate from the retina in stages.  When it separates from the peripheral retina, it can cause a retinal tear or hole.

Retinal holes and tears can have many symptoms.  Flashes and floaters are common with a benign vitreous detachment as well as a more serious retinal tear.  That is why we recommend patients with new flashes and floaters be evaluated by an eye care professional.  Some retinal tears have no symptoms and are discovered on routine exam.

A retinal tear is a serious condition because it can lead to a retinal detachment.  A retinal detachment occurs when the fluid of the vitreous tracks underneath the layers of the retina through the tear.

If a retinal tear is discovered, often it can be treated before it leads to a detachment.  The treatment involves a "welding" process where either laser or freezing is placed around the tear to "glue" it in place.  This is not a guaranteed fix because the tear can sometimes pull through the treatment and evolve into a detachment, but is often very successful.

If you have symptoms of a retinal tear please consult an eye care professional.

This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional for medical advice.