Repairing Retinal Detachment Through Scleral Buckling

Reparing retinal detachment with scleral buckling works more than 80 percent of the time with one operation. But a reattached retina doesn't guarantee normal vision. How well you see following surgery depends in part on whether the macula was affected by the detachment before surgery, and if it was, for how long. Your sight isn't likely to return to normal if the macula was detached.

Repairing Retinal Detachment Through Scleral Buckling

Even if the macula wasn't affected and scleral buckling successfully repairs your retina, you have a 10 percent chance of losing some vision due to wrinkling, or puckering, of the macula.


If the first operation fails, your doctor usually can try to reattach the retina with one or more additional operations. Additional surgery increases the rate of successful reattachment to more than 90 percent.
 
Scarring. Scleral buckling is generally successful, but sometimes - in approximately 5 percent to 10 percent of the procedures - the retina fails to reattach to the choroid. This is often due to the formation of scar tissue on the retinal surface. Scar tissue present even before the operation can pull on the retina and prevent it from reattaching. The pull of scar tissue that forms after the operation can cause the retina to separate again after having been attached during surgery. This usually happens 1 to 2 months following surgery, 

This condition is treated by removing the scar tissue with a procedure called a vitrectomy and redoing the scleral buckling, in some complicated case, the surgeon injects air, other gases or silicone oil into the vitreous cavity to push the retina back against the wall of the eye. Eventually your eye absorbs the air or gas and replaces it with fluid that the eye normally produces. Silicone, however, doesn't get absorbed and has to be removed once the retina is reattached and healed completely.

Complications. Complications occur infrequently but should be mentioned. Any one of them can result in the need for more surgery, the loss of some or all vision in the eye that was operated on, or in rare instances, the loss of that eye. They are:

• Bleeding under the retina or into the vitreous cavity. This can occur while subretinal fluid is being drained or when a buckle suture inadvertently perforates the sclera and enters the eye.
• Increased pressure inside your eyeball (glaucoma). This is due to a swelling of the choroid and narrowing of the angle in the anterior chamber.
• Double vision (diplopia). This is caused by interference from the buckle with the function of muscles that keep your eyes aligned. It may be temporary. If it's not it may require corrective glasses or surgery on the eye muscles. 

Vitrectomy. Occasionally, bleeding or inflammation clouds the vitreous and blocks the surgeon's view of the detached retina. In other instances scar tissue makes it impossible to repair a retinal detachment with pneumatic retinopexy or scleral buckling alone. In these situations a procedure called vitrectomy can remove the clouded vitreous or scar tissue.
 
The surgeon accomplishes this with a variety of delicate instruments passed into the eyeball through small openings in the sclera. These instruments include a light probe that illuminates the inside of the eye, a cutter to remove vitreous or scar tissue and an infusion tube that replaces the volume of removed tissue with a balanced salt solution to maintain the normal pressure and shape of the eye.
 
After the vitrectomy is completed, the surgeon performs the scleral buckling procedure and may fill the inside of your eye with air, gas or silicone oil to help seal the retina against the wall of the eye.
 
Vitrectomy may also be performed for conditions other than complicated retinal detachments, including:

• Vitreous clouding by blood that prevents light from reaching the retina
• Macular puckers (epiretinal membranes)
• Infection inside the eye (endophthalmitis) 
• A foreign body inside the eye 

Vitrectomy surgery typically lasts 1 to 2 hours but may take significantly longer in more complex cases. The complex cases are often done under general anesthesia, and shorter procedures are usually performed under local anesthesia.
 
Following surgery. You can experience some discomfort and a scratchy sensation in your eye. Severe pain is unlikely. If it does occur, let your surgeon know immediately. You can expect your eye to be red, swollen, watery and slightly sore for up to a month following any of the surgical procedures described above. Wearing an eye patch may provide some relief. Your doctor may also prescribe antibacterial or dilating eyedrops to help the healing process. You'll have to avoid strenuous activities during this time. It'll take about 8 to 10 weeks for your eye to heal fully. Then your doctor will examine your eyes to determine your postoperative vision and, if you wear eyeglasses, whether you need a new prescription.
 
Your vision may take many months to improve following surgery to repair a complicated retinal detachment. Some people don't recover any lost vision.
 

Repairing Retinal Detachment Through Scleral Buckling

Complications. The complications of vitrectomy are similar to those for other types of retinal detachment surgery. They include a retinal tear, redetachment of the retina, a cataract or an infection. Any of these complications can lead to partial or complete loss of vision in the affected eye or, rarely, loss of the eye itself. How much vision you retain will depend on the severity of the detachment.
 
Prompt action can save your sight
 
If you notice the warning signs of a retinal detachment, talk with your ophthalmologist immediately. Prompt action can save your vision. Your ophthalmologist can tell you about the various risks and benefits of all your treatment options. Together you can determine what treatment is appropriate for you. To find out more, you can check out Repairing Retinal Detachment Through Scleral Buckling.