Surgery

Surgery for retinal detachment

Surgery is the only treatment for retinal detachment. The goals of surgery are:

• To reattach the retina. See a picture of a detached retina.
• To prevent or reverse vision loss.

Almost all retinal detachments can be repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy.

But even with such a high rate of success for surgery, it is important to act quickly. The longer you wait to have surgery, the lower the chances that good vision will be restored. When the retina loses contact with its supporting layers, vision begins to get worse. An eye doctor (ophthalmologist) who specializes in retinal detachments will usually do surgery within a few days of your being diagnosed with a detachment.

How soon you need surgery usually depends on whether the retinal detachment has or could spread far enough to affect central vision. When the macula, the part of the retina that provides central vision, 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 has become detached, surgery may occur a few days later than it would have otherwise. Good vision after surgery is still possible but less likely.

Your doctor will decide how soon you need surgery based on the result of the retinal exam and the doctor's experience in treating retinal detachment.

Surgery for retinal tears

Treating a retinal tear may be useful if the tear is likely to lead to detachment. Symptoms such as floaters or flashing lights are key factors in deciding whether to treat a tear. A tear that occurs right after a posterior vitreous detachment (PVD) with symptoms is usually much more dangerous and more likely to progress to a retinal detachment than one that occurs without symptoms.

In deciding when to treat a retinal tear, your doctor will evaluate whether the torn retina is likely to detach. If the tear is very likely to lead to detachment, treatment can usually repair it and prevent detachment and potential vision loss. If the tear is not likely to lead to detachment, you may not need treatment.

Surgery choices

Common methods of repairing a retinal detachment include:

• Pneumatic retinopexy. In this procedure, your eye 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, flattening it so that the fluid below it can be reabsorbed. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
• Scleral buckling surgery. Your eye 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, preventing tears from getting worse, and it supports the layers of the retina.
• Vitrectomy. This is the removal of the vitreous gel from the eye. Vitrectomy gives your eye doctor better access to the retina and other tissues. It allows him or her to peel scar tissue off the retina, repair holes, close very large tears, and directly flatten a retinal detachment.