Surgery for Retinal Detachment

At the back of every eye is a film that is light sensitive. When retinal detachment occurs there is a separation of the retina from the eye’s inner wall.  This will happen because there is a tear or a hole which has developed and will allow the passage of fluid under the retina.

The symptoms of retinal detachment can be very alarming and patients commonly become very anxious and stressed. There is no doubt that this is for good reason because eyesight can be threatened by a detached retina. Anybody who suffers a detached retina needs to see an eye surgeon as soon as possible.

The risk of detachment of the retina will increase, naturally, as we age but there are people in certain groups who are at a greater risk.  People who are myopic [short-sighted] or who have had cataracts removed, or those who have suffered some sort of trauma to the eye will be generally thought to be more at risk than others. There is also sometimes a familial link to retinal detachment but this is much rarer.

How is a retinal detachment treated?

A patient who suffers a retinal detachment will usually require surgery where an ophthalmic surgeon will seal any hole that has developed in the retina and will also work to re- attach the retina.  There are two commonly used surgeries for retinal detachment and those are called scleral buckle and vitrectomy or surgery that involves use of both methods.

What happens with a vitrectomy?

This surgery carried out using microincision to repair a retinal detachment.  During the surgery the vitreous gel that has leaked due to the retinal tear will be removed so that the tear can be sealed. The surgeon will then use a freezing probe or laser to effect scarring around the site of the tear. A bubble made from gas or silicon oil will be placed in the eye so that the retina is supported during the healing process.  This gas bubble will be absorbed over the following two to eight weeks.  If an oil bubble of silicon has been used, a further small procedure will be carried out at a later date to remove it. It is quite likely that vision will be blurred after the procedure to insert a silicon oil or gas bubble. There may be some specific instructions in relation to the oil or the gas bubble but your surgeon will explain these fully to you at the time.

What happens during a scleral buckle procedure?

Repair and sealing of a retinal hole can also be achieved by having a piece of sponge or silicon stitched onto the outer wall of the eye, where it will act similar to a splint, making a slight dent in the eye which in turn will push the outer wall upwards to meet the retinal hole. You cannot see a scleral buckle from the outside and this will normally be left in place on a permanent basis

What is meant by the term ‘posturing’?

This term is commonly applied when you have had an oil or a gas bubble inserted into the eye. In this case your surgeon may ask you to ‘posture’ and that means keeping your head held in a certain position so that the oil or the gas bubble can be allowed to float into the optimum position where it can support your retina. There are several different positions that come under the heading of ‘posturing’ but your ophthalmic surgeon will explain very clearly what is needed in your particular case. This is probably the most difficult part of the recovery following your surgery but it really is extremely important but you carry out the posturing prescribed to you, usually for around 45 minutes in each hour during each day.  For the remaining 15 minutes of the hour it is usually suggested that you do a little gentle exercise to avoid stiffness due to the time you have to remain inactive.

What symptoms indicate that there may be a retinal detachment?

Retinal detachment symptoms can involve a slow build up, sometimes even over several weeks or be very sudden in onset.  if you have symptoms then you must seek assessment as a matter of urgency and certainly within 24 hours.  These are the signs you need to look for

• The appearance of floating lines or dots in your vision
• A build-up of the floaters that you can see in your field of vision
• A bright flash or bright flashes of light in your vision
• The appearance of a very dark shadow almost like a curtain being drawn over your vision
• Distorted or blurred vision and deteriorating eyesight

Any of these symptoms mean that you should seek medical attention as a matter of urgency. If you do not have an ophthalmologist, attend an accident emergency department or specialist eye hospital where you can be seen and/or referred,

Optimal Vision and retinal detachment diagnosis

At Optimal Vision we have cutting edge technology that helps us to diagnose eye disease accurately. If you are suspected of having a retinal detachment our ophthalmologist will be looking at the back of your eye through an ophthalmoscope. Another piece of equipment that may be used is a slit lamp, this is a specialist microscope used for ophthalmic purposes. The microscope is equipped with an extremely strong light that will allow the eye surgeon to examine the eye from all directions.

You will have drops applied to your eyes so that the pupils open up giving the ophthalmologist a better view of the retina. These drops may affect how you see for a short time so if you have to come for an examination it's better to bring somebody else with you who can drive you home.

If, after examination, your surgeon thinks that you do have a retinal tear, more investigations may be asked for. One of these could be an ultrasound scan.  The results of your tests will be discussed with you by your surgeon and a treatment plan drawn up for you.  It should be stressed again that it is extremely important that you come urgently if you suffer any of these symptoms, so that any further damage the eyes is minimalised. 

Is retinal detachment surgery carried out under anaesthetic?

In fact, retinal detachment surgery can be carried out under local or general anaesthesia.  If your operation is carried out under local anaesthesia although you will be awake there will be no pain or discomfort because your eye will first be numbed fully, with an anaesthetic injection. You will see nothing of the operation and your other eye that is not being operated on will have a cover over it. If your operation is done under a general anaesthetic you will be asleep throughout. Whether you have local or general anaesthesia will be a decision made by your surgeon in consultation with you, however it should be pointed out that if scleral buckle surgery is to be carried out, this is usually done using general anaesthetic.

What will the benefit of surgery for a detached retina be?

The most obvious and the most crucial is the prevention of blindness in the eye that has been affected by the detachment. It is possible that your vision has already suffered loss from the detachment, and even if surgery has been successful there may still be a deficit

Does surgery for detached retina come with any risks?

This operation has a success rate of more than ninety per cent. However, surgery for detached retina isn’t always a success. Each patient is an individual and their case will be different, with some detachments being more difficult to treat than others.  In some cases patients may also need follow on operations.  The risks of this kind of surgery will be discussed fully before you consent to any operation. 

1. If an oil or a gas bubble has been used during your retinal surgery then cataract development in that eye in the following 18 months is very common.  Cataract is where the lens that is behind your eye will cloud.  If this does happen a short operation can be undertaken to remove the cataract.
2. There is, as with any other surgery the risk of haemorrhage.

1. Infection Is another risk associated with any kind of surgery although in the case of retinal surgery for detachment this risk is around one case in every thousand. However, if this does occur the consequence may be blindness.

What do I need to do after my retinal surgery?

Although having a retinal detachment repair is a major procedure, the recovery period is not associated with a lot of pain. There will be some discomfort but simple over the counter painkillers will usually be sufficient to deal with this.

The white part of your eye will appear red and your eyelid might also be swollen after you've had your surgery. Additionally the eye may water a little bit and you might feel a gritty type of sensation in the month after your surgery as any stitches that have been inserted, dissolve gradually, during that time.  All these symptoms will resolve in time. 

You will usually find that your vision will be blurred for several weeks after you've had your retinal surgery but this will also improve slowly. The result of the surgery and what vision you have will probably not be apparent for many weeks or even months and you may also require a new prescription for your glasses. The outcome of your operation and the final vision that you achieve will very much depend on the type of detachment you have suffered. Your surgeon will be able to answer any questions that you have about the specific surgery you have undergone.

After my operation will I need to use eye drops?

Yes you will be asked to use some steroid eye drops that will help to reduce any inflammation and you will also be given some antibiotic eye drops to guard against infection. Some other drops may also be prescribed to keep your internal eye pressure normal. You will have your drops and their use explained to you before you leave hospital and you should continue to use them until you see the doctor post operatively, when new instructions may be given.

After my surgery what activities can I do?

Firstly, as we discussed earlier, if there are any posturing instructions, you need to follow these very carefully.  You can have a shower or take a bath but you need to avoid getting water in your eyes.  The general advice is that you can do anything that you feel comfortable doing but most people would not drive for several weeks after their operation.

if you have had a gas bubble inserted during your retinal surgery it is extremely important that you understand you cannot fly until that gas bubble is no longer there. Additionally if you need to have surgery for any other reason you need to tell your anaesthetist that e a gas bubble in your eye.

How long will I have to stay off work?

In general a period of around a fortnight off work should be sufficient although sometimes the recovery period may take longer.  If a gas bubble has been inserted you will find your vision is not very good and that judging distances is difficult.  Therefore it depends on the type of work that you're doing as to how long you need to stay off.  Discuss this with your surgeon who will advise you.

Why choose Optimal Vision?

Every single one of the patients who comes to our clinic can be assured that they will receive the best quality care and the attention from some of the most eminent ophthalmologists in the UK.  Our surgeons are all holders of consultant positions within our organisation, and we welcome your choice of surgeon to work with, for your eye surgery.

The basis of all our care is continuity.  All your treatment will be carried out by the same consultant who will follow you through to your discharge from our care.