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Retinal Detachment Repair
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Retinal Detachment Repair

En Español (Spanish Version)

Definition

The repair of a detached retina in the eye. The retina is a thin sheet of light-sensitive nerve tissue and blood vessels that line the back of the eye. The sensory layer of the retina, which receives images and transmits them to the brain, can be pulled away (detached) from its normal position in the back wall of the eye, resulting in vision loss. The retina often detaches from the back of the eye in a manner similar to wallpaper peeling off of a wall. The detachment is usually preceded by a hole or tear in the retina.

Detached Retina

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Parts of the Body Involved

Eye

Reasons for Procedure

To place the retina back into its proper position on the back of the eye, with the hopes of restoring vision

Risk Factors for Complications During the Procedure

There are many factors that can cause complications during retinal surgery. They include, but are not limited to, general health, degree of retinal disease, cataracts , and glaucoma .

What to Expect

Prior to Procedure

Your ophthalmologist will perform a comprehensive eye examination, likely including some or all of the following:

  • Visual acuity—Your vision will be checked using a chart with letters or numbers.
  • Slit lamp examination—Using a special type of magnified instrument, your ophthalmologist will examine the front of your eye.
  • Tonometry—The pressure inside your eye will be measured.
  • Dilated retinal exam—After giving you special drops to dilate (enlarge) your pupils, your ophthalmologist will perform a thorough examination of your retina using special lights and lenses.
  • B-scan—Your ophthalmologist may use a special ultrasound instrument to view the inside of the eye.

Besides examining your eyes, you will likely have a general medical examination prior to your surgery. This will likely include some or all of the following:

  • Blood and urine tests
  • Chest x-ray—a test that uses radiation to take a picture of structures inside the body
  • Electrocardiogram (EKG)—a measure of the electrical activity of the heart

During Procedure

Anesthesia will be administered.

Anesthesia

Local via an injection similar to what is used at a dentist’s office, or general , depending on the type of procedure done, the age of the patient, and other factors

Description of the Procedure

There are several surgical options to repair retinal detachment. The most common are:

Scleral Buckle

A flexible silicone band is permanently stitched to the outside surface of the back of the eye. (This is done underneath the conjunctiva, the “skin” of the eye, so you would never see the band.) This band acts like a belt that "buckles" the area containing the retinal tear or detachment to the wall of the eye. This procedure has a high success rate in re-attaching the retina. Local or general anesthesia is used.

Pneumatic Retinopexy

A gas bubble is injected into the vitreous cavity inside of the eye, which forces the retina back into position. You usually need to lie in a special position to keep the gas bubble in place. The retina usually re-attaches within several days. Usually, your ophthalmologist will help seal the retina back into place against the wall of the eye with laser photocoagulation or cryotherapy. Laser photocoagulation uses heat, in the form of laser light, while cryotherapy uses extreme cold to seal the retina.

This treatment method generally has a high success rate; however, it is not suitable for all types of detachment. Local anesthesia is sometimes used. The main benefit of this procedure is that it can be done in the office with just topical anesthetic drops.

Vitrectomy (Removal of the Vitreous Humor)

This procedure may be required for more complicated retinal detachments, or if the procedures described above are not successful. This procedure removes the vitreous jelly as well as any scar tissue, and replaces it with a gas bubble or specialized oil known as silicone oil. This gas bubble/silicone oil helps push the retina back against the eye wall. Then, laser photocoagulation or cryotherapy is often used to seal retinal breaks. Many times, your surgeon will perform a scleral buckle procedure at the same times as the vitrectomy. Local or general anesthesia is used.

After Procedure

Your eye will be covered with a bandage and metal shield for one day after the surgery.

How Long Will It Take?

Generally, 1 to 4 hours, depending on which procedure is done

Will It Hurt?

Anesthesia prevents pain during the procedure. During recovery, you may experience some pain or nausea, but your doctor can give you pain medication to relieve this discomfort.

Possible Complications

  • Redetachment of the retina—Sometimes, the retina detaches again following surgery, requiring additional surgery. In severe cases, this complication may be irreversible.
  • Endophthalmitis—a serious infection that can occur inside the eye
  • Proliferative vitreoretinopathy—In rare cases, this condition causes progressive contraction and scarring of the retina after retinal detachment repair, which may necessitate additional surgery. In severe cases, this complication may be irreversible.

Average Hospital Stay

You usually go home the same day as the surgery.

Postoperative Care

  • Do not remove the patch until instructed to do so by your surgeon (usually at the one day follow-up appointment).
  • If your doctor instructs you to keep your head in a certain position, do so as much as possible, even when eating, sleeping, and bathing.
  • Do not allow your eye to come into contact with running water, until allowed by your doctor.
  • Avoid strenuous physical activity for a few weeks after surgery, until allowed by your ophthalmologist.
  • Your ophthalmologist will schedule follow-up appointments to monitor your recovery.

Outcome

The outcome of this procedure depends on several factors, including your vision before the surgery, and the location and extent of detachment. If your vision was good prior to the procedure, a successful operation usually restores vision to good levels. However, if vision was poor prior to surgery, final visual return may be slow and remain incomplete after surgery. In addition, a peripheral retinal detachment will likely heal quicker than one that involves the macula (central retina), or total detachment.

In any case, the final visual result may not be known for 1 to 2 years after surgery.

You can often return to work within 1 to 2 weeks after surgery, if cleared by your ophthalmologist.

Call Your Doctor Immediately If Any of the Following Occurs

  • Any change in vision
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the surgical site
  • Any other problems

RESOURCES:

American Academy of Opthalmology
http://www.aao.org

American Association of Eye and Ear Hospitals
http://www.aaeeh.org

CANADIAN RESOURCES:

Canadian Association of Optometrists
http://www.opto.ca/en/public/

University of Ottawa Eye Institute
http://www.eyeinstitute.net/main.html

References:

Charles Retina Institute website. Available at: http://www.charles-retina.com/ .

Digital Journal of Ophthalmology . Harvard University.

Kanski JJ. Clinical Ophthalmology: A Systemic Approach . 4th ed. Butterworth Heinemann; 1999.

The Schepens Eye Research Institute website. Available at: http://www.schepens.harvard.edu/ .



Last reviewed December 2007 by Alexander J. Anetakis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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