Surgery For Retinal Detachment

Three different surgical procedures are commonly used to repair a retinal detachment: pneumatic retinopexy, scleral buckling and vitrectomy. Some of these procedures are done in conjunction with cryopexy. The purpose of these treatments is to close any retinal holes or tears and to reduce the tug on the retina from a shrinking vitreous. The severity and complexity of your condition will determine which procedure your eye surgeon recommends.

Surgery For Retinal Detachment

Pneumatic retinopexy. Pneumatic retinopexy is a surgical technique used for an uncomplicated detachment when the tear is located in the upper half of the retina. It's done on an outpatient basis using local anesthesia. First the surgeon performs cryopexy around the retinal tear. Then he or she withdraws a small amount of fluid from the anterior chamber to soften the eye and injects a bubble of expandable gas into the vitreous cavity. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear.
 
With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of the eye,
 
Following surgery. You may have to hold your head in a cocked position for a few days after surgery, to make sure the gas bubble seals the retinal tear. It takes 2 to 6 weeks for the bubble to disappear. Until the gas is gone from your eye, you have to avoid lying or sleeping on your back. This keeps the bubble away from your lens and reduces the risk of cataract formation or a sudden pressure increase in your eye,
 
During that time you can't travel by airplane or be at a high altitude because a sudden drop in pressure would cause the gas bubble to expand rapidly, resulting in dangerously high pressure in your eye. Check with your surgeon on when this danger has passed.

The success rate of pneumatic retinopexy isn't as good as that of scleral buckling. However, it can avoid a trip to the operating room and the need for incisional (cutting) surgery.
 
Complications. The complications of pneumatic retinopexy may include:

• Recurring retinal detachment
• Excessive scar tissue formation in the vitreous and retina
• Cataracts 
• Glaucoma 
• Gas getting under the retina 
• Infection 

These complications are rare, but if they do occur and go untreated, they can cause severe loss of vision. A recurring retinal detachment can usually be repaired with scleral buckling or vitrectomy.
 
Scleral buckling. Scleral buckling is the most common surgery for repairing retinal detachment. It's usually done in an operating room under local or general anesthesia. If you have an uncomplicated retinal detachment, this surgery may be done on an outpatient basis.
 
First the surgeon opens the conjunctiva and treats the retinal tears or holes with cryopexy. Then he or she indents (buckles) the sclera over the affected area by pressing in with a piece of silicone. The silicone material is either in the form of a soft sponge or a solid piece. The buckle closes the tear and helps reduce the circumference of the eveball, thereby preventing further vitreous pulling and separation. When you have several tears or holes or an extensive detachment, the surgeon may create an encircling scleral buckle around the entire circumference of the eye.

Surgery For Retinal Detachment

The scleral buckle is stitched to the outer surface of the sclera. Before tying the sutures holding the buckle in place, the surgeon may make a small cut in the sclera and drain any fluid that has collected under the detached retina. The buckle is then covered with the conjunctiva. Once the incision heals, there is little evidence of the operation, and the buckle remains in place for the rest of your life. Some surgeons may choose a temporary buckle for simple retinal detachments, using a small rubber balloon that's inflated and later removed. To find out more, you can check out Surgery For Retinal Detachment.