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* Ocular Anatomy And Function

* The Vitreous

* Retinal Tear And Vitreous Hemorrhage

* Treatment Of Retinal Tear

* Retinal Detachment

* Scleral Buckling Surgery For Retinal Detachment

* Pneumatic Retinopexy

* Vitreous Surgery (Vitrectomy)

* Vitreous Hemorrhage And Retinal Detachment

* Proliferative Vtireoretinopathy (PVR)

* Giant Retinal Tear

* Diabetic Retinopathy

* Epiretinal Membrane (Macular Pucker)

* Intraocular Infection: Endophthalmitis

* Retinal Detachment With CMV Retinitis

* Trauma And Intraocular Foreign Body

* Dislocated Lens

* Macular Hole

* Submacular Surgery

* FAQ's About Retinal Detachment

Scleral Buckling Surgery For Retinal Detachment.

If the retina has become detached and the detachment is too large for laser treatment or cryotherapy alone, surgery is necessary to "reattach" the retina. Without some type of retinal reattachment surgery, vision will almost always be completely lost. There are two types of surgery for retinal detachment; one is called scleral buckling surgery and the other is called pneumatic retinopexy.

Scleral Buckling Surgery Image.

The traditional surgery for retinal detachment is scleral buckling surgery. This surgery is generally performed in the operating room under general anesthesia but, in some cases, may be performed under local anesthesia. The surgeon first treats the retinal tear with cryotherapy. A cryoprobe is placed on the outside part of the eye (the sclera) as the surgeon looks into the eye. The surgeon then places the cryoprobe in the correct position and the retinal tear is treated. A piece of silicone plastic or sponge is then sewn onto the outside wall of the eye (sclera) over the site of the retinal tear. This pushes the sclera in toward the retinal tear and holds the retina against the sclera until scarring from the crotherapy seals the tear. This surgery is called scleral buckling becauses the sclera is buckled (pushed) in by the silicone. The silicone buckle is left on the eye permanently. Another type of scleral buckling surgery for retinal detachment can be done with a small rubber balloon which is left on the eye only a few days and is then removed.

The silicone may also be placed all around the outside circumference of the eye. This is called an encircling scleral buckle or band. The purpose of the encircling scleral buckle is to lessen the pulling of the vitreous on the retina. During the surgery, the surgeon may drain the fluid from beneath the retina by making a tiny slit in the sclera, and then making a small puncture into the space under the retina. The fluid under the retina then drains out through the slit in the sclera.

Scleral Buckling Surgery Image 2.

Occasionally, the surgeon may place a gas bubble into the vitreous cavity. When the surgery is over, the patient is positioned so that the gas bubble rises and pushes the retinal tear against the scleral buckle to help keep the tear closed.

In most cases, there is better than 80% chance of sucessfully reattaching the retina with one operation. But successful reattachment does not necssarily mean restored vision. The return of good vision after surgery depends on whether, and for how long, the macula was detached prior to surgery. If the macula was detached, vision rarely returns to normal. Still, if the retina is successfully reattached, vision usually improves. The best vision may not occur for many months after surgery.

Postoperative Period: following surgery, the eye will be red and slightly sore for a month or two. Patients often feel a scratchy sensation produced by the stitches used to close the lining around the eye. Severe pain is uncommon; if it occurs, the surgeon should be told immediately. The eye will water for several weeks, and the patient may find it more comfortable to wear a patch on the operated eye. Usually, several medicines given as eye drops must be taken after the surgery. These should be continued until the surgeon asks the patient to stop. These drops are used to prevent infection and to help make the eye feel more comfortable. In most cases, the patient may leave the hospital within a day or two of the surgery, or even the day of the surgery. Each surgeon handles treatment differently, and each case is unique.

Following the surgery, vision will be blurry; it may take many weeks for the vision to improve. During this period the main concern is that the retina remains attached. Many surgeons ask their patients to restrict their physical activity for several weeks.

Complications of scleral buckling: even though the surgery for retinal detachment is generally successful, certain complications can occur. Any one of these complications can result in failure of the operations, loss of some or all vision, and, in rare situations, even loss of the eye.

Retinal detachment surgery done by scleral buckling can affect the eye muscles that move the eye and keep the eye straight. This can result in double vision, which on rare occasions is permanent. Retinal detachment surgery can also cause bleeding under the retina, cataract formation, glaucoma, retinal redetachment, proliferative vitreoretinopathy, vitreous hemorrhage, drooping of the upper lid, and infection. Although any one of these can result in the need for some surgery, or in the total loss of vision, these complications are very infrequent. Retinal redetachment is the most commonly occurring problem. If this occurs, your surgeon will discuss the chance that a reoperation will successfully reattach the retina.


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