SURGICAL SERVICES

Retinal Detachment Repair

Almost all retinal detachments can be repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy. But even with a high rate of success for surgery, it is important to act quickly. The longer you wait to have surgery, the lower your chances of restoring good vision will be. 

When the retina loses contact with its supporting layers, vision begins to get worse. An eye doctor (ophthalmologist) who specializes in retinal detachments will usually do surgery within a few days of your being diagnosed with a detachment.

How soon you need surgery usually depends on whether the retinal detachment has or could spread far enough to affect central vision. When the macula (the part of the retina that provides central vision) loses contact with the layer beneath it, it quickly loses its ability to process what the eye sees. Having surgery while the macula is still attached will usually save vision. If the macula has become detached, surgery may occur a few days later than it would have otherwise. Good vision after surgery is still possible but less likely. 

Your doctor will decide how soon you need surgery based on the result of the retinal exam and the doctor’s experience in treating retinal detachment.

Vitrectomy

This is an increasingly common treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble (SF6 or C3F8 gas) or silicone oil. An advantage of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks. Silicone oil (PDMS) needs to be removed after a period of two to eight months, depending on the surgeon’s preference. Silicone oil is more commonly used in cases associated with proliferative vitreoretinopathy (PVR). 

A disadvantage to vitrectomy is that it always leads to more rapid progression of a cataract in the operated eye. In many places, vitrectomy is the most commonly performed operation for the treatment of retinal detachment.

Scleral Buckling Surgery

Your eye doctor places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves pulling (traction) on the retina, preventing tears from getting worse, and it supports the layers of the retina.

Epiretinal Membrane Peel

The surgeon can remove or peel the membrane through the sclera and improve vision by two or more Snellen lines. Usually the vitreous is replaced at the same time with clear (BSS) fluid in a vitrectomy. 

Surgery is not usually recommended unless the distortions are severe enough to interfere with daily living since there are the usual hazards of surgery, infections, and a possible retinal detachment. More common complications are high intraocular pressure, bleeding in the eye, and cataracts, which are the most frequent complication of vitrectomy surgery. Many patients will develop a cataract within the first few years after surgery. In fact, the visual distortions and diplopia created by cataracts may sometimes be confused with epiretinal membrane.

Pneumatic Retinopexy

This is an effective in-office procedure for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is usually an outpatient procedure performed with local anesthesia.

During pneumatic retinopexy, the eye doctor (ophthalmologist) injects a gas bubble into the middle of your eyeball. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.

The bubble remains for about one to three weeks to help flatten the retina until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble.

Macular Hole Repair

This surgery involves using tiny instruments to remove the vitreous gel that is pulling on the macula. The eye is then filled with a special gas or oil bubble to help flatten the macular hole and hold the retinal tissue in place while it heals.