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.
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.
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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