What is retinal detachment surgery?

Surgery is the only treatment for retinal detachment. Without treatment, vision loss can progress from minor to severe or even to blindness. This can happen within a few hours or days.

How soon you need surgery usually depends on whether the retinal detachment has or could spread far enough to affect central vision. The macula is the part of the retina that provides central vision. If it loses contact with the layer beneath it, it quickly loses its ability to process what the eye sees.

• Having surgery while the macula is still attached will usually save vision.
• If the macula is detached, surgery may occur a few days later. Good vision after surgery is still possible. But it's less likely.

There are several types of surgery. The type you have depends on the cause and type of detachment you have, and any other eye problems. These are three of the most common types.

Pneumatic retinopexy.

The doctor injects a gas bubble into the middle of the eyeball. The gas bubble floats to the detached area and lightly presses the detached retina to the wall of the eye. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear.

Scleral buckling surgery.

The doctor places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves pulling (traction) on the retina. It gently presses the wall of the eye to the retina, so that the retina will reattach. It also helps prevent a retinal tear from getting worse.

Vitrectomy.

The doctor removes the vitreous gel from the eye. This gives the doctor better access to the retina and other tissues. It allows the doctor to remove scar tissue from the retina, repair holes and tears, and push the retina back onto the wall of the eye so that it reattaches.

If scar tissue from the first surgery grows over the surface of your retina, you may need more than one surgery.

Things that may make surgery harder include:

• Glaucoma.
• Pupils that won't get larger (dilate).
• Infection inside or outside the eye.
• Scarring from previous surgery.
• Bleeding (hemorrhage) in the vitreous gel.
• Scars on or cloudiness in the cornea.
• Clouding of the lens. (This is called a cataract.)

Activity

• Rest when you feel tired.
• Allow the eye to heal. Don't do things where you might move your head. This includes moving quickly, lifting anything heavy, or doing activities such as cleaning or gardening.
• You will probably need to take 2 to 4 weeks off from work. It depends on the type of work you do and how you feel.
• You may drive when your vision allows it. If you are not sure, ask your doctor.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• You will need to use eye drops for up to 6 weeks.

Ice and elevation

• Close your eye and put ice or a cold pack on it for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.

Other instructions

• Ask your doctor when you can wash your hair and face. You will need to be careful not to get any soap or water in your eye. You may want to use a washcloth to gently wash your face.
• Wear sunglasses during the day. You may have to wear an eye patch or shield for a few days.
• If your doctor used a gas bubble to hold the retina in place, you'll have to keep your head in a certain position for a few days or longer after the surgery. Your doctor will give you special instructions about this.
  • Do not lie on your back. The bubble will move to the front of the eye and press against the lens instead of the retina.
  • Airplane travel is dangerous. This is because the change in altitude may cause the gas bubble to expand and increase the pressure inside the eye.

A retinal detachment usually needs to be repaired quickly. You may not have much time to think about it.

The retina is a thin nerve membrane that lines the back of the eye. You can't see without it. Detachment means the retina has moved out of its normal place against the back of the eye.

Detachment can lead to severe vision loss or blindness. Prompt treatment can restore good vision.

You may have some pain in your eye and your vision may be blurry for a few days after the surgery. Your eye may be swollen, red, or tender for several weeks. Your eye doctor may put drops in your eye that prevent infection and keep the pupil from opening wide (dilating) or closing (constricting). You may have to wear a patch over the eye for a day or more.

You have had surgery to fix a retinal detachment. Your doctor may also have fixed a tear in your retina.

Your eye doctor may put drops in your eye to prevent infection and keep the pupil from opening wide or closing. You will also use these drops at home. You may have to wear a patch or shield over the eye for a day or more. You may have some pain in your eye and your vision may be blurry for a few days after the surgery. Your eye may be swollen, red, or tender for several weeks.

If your doctor used a gas bubble to flatten your retina during surgery, you may have to keep your head in a certain position for a few days or longer. Your doctor will give you special instructions about this.

You will need 2 to 4 weeks to recover before returning to your normal activities.

Surgery is the only way to reattach the retina. There are many ways to do the surgery. They include:

• Pneumatic retinopexy. Your doctor injects a gas bubble into the middle of the eyeball. The gas bubble floats to the detached area and presses lightly against the detached retina. This flattens the retina against the wall of the eye. The retina reattaches.
• Scleral buckling. Your doctor places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves the force that is pulling and detaching the retina. The doctor may also use a gas bubble to flatten the retina against the wall of the eye.
• Vitrectomy. Your doctor inserts small surgical tools into the eye. Then the doctor cuts the vitreous gel and suctions it out. (Vitreous gel fills the large space in the middle of the eye.) At the end of the surgery, silicone oil or a gas bubble is injected into the eye. This keeps the retina in place.

If a tear in the retina caused the detachment, your doctor may fix it during your surgery. This can be done in two ways. The doctor may use:

• A laser beam that burns around the tear. The burn forms scars that close the tear. This is called laser photocoagulation.
• A probe that freezes around the tear to fix it. This is called cryopexy.