Retinal Detachment Surgery: Overview

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Retinal detachment surgery is used to repair a detached retina, which occurs when the retina—a layer of tissue that covers most of the back of the eye—separates from its anchored position.

If treatment of a detached retina is not performed immediately (within approximately 24 hours), permanent partial or complete vision loss can result.

eye surgery

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What Is Retinal Detachment Surgery?

Retinal detachment surgery is considered an emergency procedure. The goal of surgery is to reattach the retina to the back of the eye as soon as possible so that the blood supply can be reestablished. Several different procedures can be performed to repair a detached retina; the type of surgery will depend on:

  • How severe the detachment is
  • Which area of the eye is involved in the retinal detachment

In some circumstances, a person will require more than one type of surgery to effectively repair the retina.

For example, during the surgery, the healthcare provider may also utilize a laser (or use a freezing technique) to repair tears or holes in the retina while helping to hold the retina in place.

Your eye care professional will discuss with you the best course of treatment and explain the risks and benefits of each surgery type.

 Types of surgical procedures include:

Pneumatic Retinopexy 

Pneumatic retinopexy involves an injection of a very small air bubble into the eye; this bubble functions to push the retina back into place. Once the retina is back where it should be located, the surgeon will use a laser or freeze treatment to repair holes or tears.

This procedure is performed on an outpatient basis (usually in the doctor’s office). The steps involved in pneumatic retinopexy include:

  1. A numbing agent is used in the eye.
  2. A very small needle is used to remove a tiny amount of fluid.
  3. A small bubble of air is inserted into the eye (the bubble will be visible in your peripheral vision, and it will dissipate on its own in time).
  4. Freeze or laser treatment is implemented to repair holes or tears in the retina.

After Pneumatic Retinopexy

Once the surgery is complete, you will be asked to:

  • Keep your head in a specific position (such as turned to the side) for several days to maintain the position of the air bubble (your healthcare provider will give you precise instructions on head positioning)
  • Avoid strenuous exercise, heavy lifting, and other activities (such as taking an airplane flight) until your eye heals
  • Attend a follow-up visit (according to your healthcare provider’s instruction) to ensure your eye is healing properly
  • Report vision that gets worse, unrelieved pain, or excessive swelling, as well as any other concerns after the surgery

Scleral Buckle Surgery

A scleral buckle surgical procedure involves a very small, flexible band that is placed around the sclera (white part) of the eye. The band serves to gently put pressure on the sides of the eye, moving the eye inward, toward the retina. This helps the retina reattach.

Steps for scleral buckle surgery include:

  1. Anesthesia will be given, which induces sleep during the procedure.
  2. An incision into the outer coat of the eye, called the conjunctiva, will be made.
  3. The buckle is placed around the eye and surgically stitched into place.
  4. Laser or freezing techniques may be performed to prevent a retinal tear or detachment from reopening.
  5. The fluid behind the retina is drained and antibiotic eye drops are administered (to prevent infection in the eye).
  6. The buckle may be kept in place permanently or it may be a temporary buckle that will be removed once the retina has healed.
  7. Most people are discharged from the hospital the same day of surgery but won’t be allowed to drive themselves home (a person must be preassigned to be the designated driver after discharge).

After a Scleral Buckle Procedure

After your surgery, you may have some soreness of the eye. Your healthcare provider will instruct you to:

  • Wear a patch over your eye for approximately one day
  • Avoid exercise and other activities (such as heavy lifting) until your eye heals
  • Attend a follow-up visit according to your healthcare provider’s instruction to ensure your eye is healing
  • Inform your healthcare provider if your vision worsens, you have a high level of pain or swelling, or you have other questions or concerns

 

Vitrectomy

A vitrectomy procedure is similar to a pneumatic retinopexy, but it is a longer, more complicated procedure that is performed in a surgical suite in the hospital instead of in the doctor’s office.

Steps for a vitrectomy include:

  1. You may be given anesthesia to put you to sleep or you may be awake but given medication to prevent pain (such as anesthetic eye drops and injections) and help you relax.
  2. The surgeon makes an incision to the outer layer of the eye (the white area called the conjunctiva).
  3. A light is inserted into one of the incisions to view the inside of the eye.
  4. The vitreous body (the clear gel that fills the space between the lens and the retina in the eyeball) is removed through one of the incisions.
  5. A substance (such as gas, oil, a bubble of air, or another type of solution to push the retina back into place) is inserted to replace the vitreous. This substance will eventually be naturally replaced with fluid that your eye will automatically produce.
  6. The surgeon removes the fiber optic light, and any other tools, and closes the incision.
  7.  If gas or air bubbles are used, they will naturally reabsorb; if the surgeon used oil to replace the vitreous, it will need to be removed in a few months after the surgery.
  8. You may be discharged the same day or you may need to stay overnight (depending on your surgeon’s instructions)

After a Vitrectomy

After your surgery, you will be asked to:

  • Wear an eye patch over your eye for a few days
  • Take pain medication when needed according to your discharge instructions
  • Avoid any activity that involves a change in altitude, such as an airplane flight
  • Take prescribed eye drops
  • Position your head in a strategic position (usually to one side) for a long period, according to your healthcare provider’s instructions
  • Avoid driving until your healthcare provider advises that your vision has returned
  • Avoid strenuous activity and heavy lifting until your healthcare provider gives you the okay
  • Follow up with your healthcare provider as instructed to ensure your eye is healing
  • Inform your healthcare provider of any worsening in vision, unrelieved pain, or extensive swelling

Techniques

There are also some techniques used to repair a torn or detached retina, including:

  • Cryotherapy: Involves the use of a freezing probe to seal the retinal tear 
  • Laser photocoagulation: Utilizes a laser beam that is aimed at the retinal tear to seal it

Potential Risks 

There are several potential risks and complications of retinal detachment surgery, which depend on the type of surgical procedure employed. Generally, the common risks of surgery include:

  • Bleeding or infection after surgery
  • The formation of cataracts
  • Glaucoma
  • Bleeding into the vitreous body (hemorrhage)
  • Double vision or loss of vision (rarely occurs)
  • Loss of the eye (an extremely rare risk, considering the advances in modern surgical techniques)

Contraindications

Contraindications for pneumatic retinopexy surgery include:

  • Detached retina located in positions of 4 and 8 o’clock (although this is a difficult procedure to perform)
  • Poor cooperation from the person undergoing treatment
  • Vitreoretinal adhesions (scar tissue of the retina and vitreous)
  • Corneal haze
  • The inability of the patient to follow aftercare instructions

Purpose of Retinal Detachment Surgery

The overall purpose of retinal detachment surgery is to reattach the retina to the vascular choroid layer, restoring blood supply and preventing long-term vision loss.

How to Prepare

Preparing for retinal detachment surgery involves many of the same practices that other types of surgery require, such as:

  • Stopping the use of medications that cause bleeding (such as aspirin or anticoagulants)
  • Informing your surgeon if you have any health problems before surgery (such as fever, cough, or shortness of breath)
  • Withholding medications (such as diabetic medication) the morning of surgery according to your surgeon’s instructions
  • Having a preoperative visit with your primary care doctor (to ensure you are healthy enough for surgery)
  • Refraining from eating or drinking as per your surgeon’s instructions (usually starting at midnight the night before surgery)
  • Following all other preoperative instructions (such as when to shower) given to you before your surgery

What to Expect on the Day of Surgery

You will have specific instructions from your healthcare provider regarding what to do on the day of your surgery. The instructions will include where to park, where to check in, and more.

There are some general principles to follow the day of surgery, including:

  • Bring a complete list of all your medications (including dosages) and when last taken to the admitting nurse.
  • Do not wear makeup or perfume.
  • Do not wear hairpins, hair clips, combs, or clasps in your hair.
  • Leave all jewelry (including watches) and valuables at home.
  • Remove dentures, removable bridges, contact lenses, and glasses before entering the surgical suite.
  • Wear loose-fitting clothing and comfortable nonskid shoes or slippers.
  • Arrange for someone to drive you to and from the hospital.
  • Check with your surgery team to find out how many visitors can accompany you on the day of surgery

Recovery

Recovery from retinal detachment surgery depends on the type of procedure you are having, but some general recovery principles include:

  • Wearing a soft eye patch and a hard shield until your doctor checks your eyes after surgery
  • Avoiding rubbing or touching the eye
  • Expecting an uncomfortable gritty feeling if you had sutures
  • Taking OTC pain medications as directed by your healthcare provider
  • Using prescribed eye drops
  • Lying in a facedown position and positioning the head to the side
  • Expecting to see floaters and flashes of light or double vision temporarily for a few days or up to several weeks after surgery
  • Expecting your vision to return slowly
  • Asking your healthcare provider when you may resume driving and when you can perform normal physical activity
  • Wearing a medical identification wristband to notify other healthcare providers that you have a gas bubble in your eye
  • Avoiding airplane flights until your healthcare provider notifies you that the gas bubble is gone
  • Notifying your surgeon right away if you have severe eye pain

A Word From Verywell

Although there are risks of complications that could occur when you undergo any type of surgery or medical treatment, retinal detachment surgery is known to be very effective, provided that you have a prompt diagnosis and treatment.

This means seeking professional intervention from your eye care provider when you have any symptoms of retinal detachment—such as loss of vision, floaters, or flashes of light—and participating in regular eye examinations.

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Article Sources
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  2. National Eye Institute. Surgery for retinal detachment. Updated December 23, 2020.

  3. American Academy of Ophthalmology. Scleral buckling for rhegmatogenous retinal detachment.. Updated February 16, 2021.

  4. National Eye Institute. Laser surgery and freeze treatment for retinal tears. Updated December 23, 2020.

  5. Michigan Medicine. Detached retina (retinal detachment).

  6. Hillier RJ, Felfeli T, Berger AR, et al. The pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial(Pivot)Ophthalmology. doi:10.1016/j.ophtha.2018.11.014