Retinal Detachment

How to perform retinal detachment surgery?

Retinal detachment surgery is usually performed under local anesthesia, which means you will be awake during the procedure.

The eye and surrounding area will be numbed with local anesthesia to prevent any pain. You may be aware of bright lights or movement in the operating room, but you will not be able to see details of the procedure. You will be asked to lie flat and keep your head still during the operation. General anesthesia, where you are unconscious for the entire operation, is not commonly used for retinal detachment surgery. If you require general anesthesia, you will need to follow specific guidelines for eating and drinking before the operation.

To correct your retinal detachment, your surgeon will perform one of the following procedures:

Cryotherapy and scleral buckle are two procedures for sealing retinal holes. In these procedures, “splints” or buckles made of sponge or silicone material are positioned outside the white part of the eye and under the skin, usually remaining there permanently.

Vitrectomy: A vitrectomy procedure is a type of keyhole surgery for the eye that involves removing the vitreous from inside the eye through tiny openings. The surgeon then finds the breaks in the retina and seals them using laser or cryotherapy. The resulting scarring holds the break in place, and a gas bubble, air, or silicone oil is placed in the eye to act as a “splint” to hold the retina in place until the tear is sealed. The sealing process usually takes ten days to complete.

After a vitrectomy with a gas, air or silicone oil bubble, it is important to follow any specific instructions provided by your surgeon, including avoiding air travel, as changes in air pressure can cause the bubble to expand, leading to raised pressure in the eye and potentially causing visual loss.

There are different types of gas that can be used in retinal detachment surgery.

1. C3F8 can remain in the eye for up to 12 weeks.
2. SF6 can remain in the eye for up to 4 weeks.
3. C2F6 can remain in the eye for up to 8 weeks.
4. Air can remain in the eye for up to 2 weeks.

You will be informed of the type of gas or air bubble used in your surgery. For silicone oil, you should avoid flying for two weeks unless your consultant gives you clearance. Silicone oil may require removal during a subsequent minor procedure several months later. At the conclusion of the procedure, there may be small sutures on the eye, covered by a protective pad and clear shield. The pad will be removed the next day and you need to wear the clear shield only at night for three weeks after surgery.

It’s important to inform you doctor that you have gas in your eye when receiving medical attention, specifically during childbirth or emergency treatments, as nitrous oxide, which is frequently used for pain relief, could lead to problems in your eye if it reacts with the gas. If you require a general anesthetic, make sure to let the anesthetist know that you have had surgery and have gas in your eye.

What happens after the procedure?

After undergoing retinal detachment surgery, you will be given eye drops to reduce inflammation and prevent infection. You should not rub your eye and take pain medication, such as paracetamol, if needed. It is normal to experience discomfort and itching for 5-10 days after the surgery, and your eye may take 2-6 weeks to heal. You will have a follow-up appointment with your doctor within 7-14 days. It is important to rest while your eye is healing.

After your surgery, you may need to practice “posturing” for up to seven days. This involves lying or sitting in a specific position to help the gas or silicone oil bubble in your eye float up and press the retina into position while it heals. Your surgeon will advise you on posturing and give you instructions after your surgery. As the gas bubble starts to disperse, you may notice a line in your vision that moves like a spirit level. You will have clear vision above the line, but below the line your vision may be fuzzy or blurred. The length of time the gas stays in your eye depends on the type of gas used.

After the surgery, it may take several weeks for your vision to fully recover.

If a gas bubble was used, your vision may be blurred immediately after the surgery, but this is normal. The final outcome of your vision will depend on the state of your detached retina before the surgery. In most cases, central vision can be restored if the retina was diagnosed and treated quickly. However, if the affected eye already had poor central vision, full restoration may not be possible. You may not be able to read using the affected eye but you will still have peripheral vision which is important for daily activities such as walking and driving (if the other eye has normal vision).

When to seek medical advice?

you should seek advice from your doctor immediately. These symptoms may indicate an infection or a problem with the healing process, and prompt action is important to prevent further damage to your eye.

Why is the procedure to repair extremely vital ?

1. Prevents blindness
2. Restores some vision
3. Helps in recovering lost sight due to detached retina

What are the risks associated with retinal detachment surgery ?

The success of retinal detachment surgery is not guaranteed, as each case can vary in complexity. Some patients may require multiple procedures, and your doctor will thoroughly explain the potential risks and advantages of the surgery before proceeding.

1. Success rate of retinal detachment surgery is around 85-90% with a single operation, resulting in the reattachment and stability of the retina. However, there is a 5-10% chance of requiring additional surgery due to new tears, scar tissue, or redetachment.
2. Post-operative cataract formation is a possible side effect of the surgery, which typically requires separate treatment.
3. As with any surgical procedure, there is a small risk of infection and bleeding during retinal detachment surgery. These risks, although low, can result in permanent visual loss if they occur.

What are the complications of retinal detachment surgery?

Complications are rare, and in most instances, they may be adequately treated. Some problems may result in blindness very infrequently.

1. Bruising of the eye or eyelids can occur post-surgery.
2. High pressure and inflammation inside the eye are also potential side effects.
3. A risk of developing a cataract in the operated eye exists.
4. Double vision is another potential complication.
5. An allergy to the medication used during the procedure can occur.
6. Although rare, endophthalmitis (an infection in the eye) can occur, potentially leading to serious vision loss.
7. Cataract – People who have had a detached retina or surgery are more susceptible to developing cataracts. The treatment involves removing the cloudy lens and replacing it with a new, artificial plastic lens.

When to indicate further surgery?

If you are part of the 5-10% of patients who develop another retinal tear or scar tissue, additional surgeries will be required. The eye’s attempt to heal a detached retina can lead to the formation of scar tissue and retinal contraction, known as proliferative vitreoretinopathy (PVR), which is associated with decreased vision and the potential for redetachment even after successful initial surgery.

If you are looking for Retinal Detachment Treatment in Andheri West, Mumbai visit Dr. Vaidya Eye Hospital or Call on 90044 96621