Retinal detachment surgery

About retinal detachments

A retinal detachment occurs when the retina peels away from the inner wall of the eye. The retina is the light sensitive tissue at the back of the eye.

A retinal detachment usually happens because a hole or tear has formed in the retina, allowing fluid to enter beneath the retina (see eye diagram below).

Treatment

Treatment is surgery to seal the holes in the retina and reattach the retina.

There are two main surgical methods: vitrectomy [add link] and scleral buckle.

Vitrectomy

A vitrectomy is an operation to remove the vitreous gel from inside your eye. This allows us to gain access to the retinal hole or tear, which we seal using either laser or a freezing probe (cryotherapy).

A vitrectomy takes 1 to 2 hours, depending on complexity.

It involves the following.

• We perform a vitrectomy while you are under local anaesthetic with sedation. This means you are awake but do not feel any discomfort because we numb your eye with an injection.  We also give you some medicine through a vein to help you relax.
• We inject a gas bubble into your eye to hold the retina in place. This blurs your vision until the gas bubble slowly reabsorbs over 2 to 8 weeks. Sometimes we use silicone oil instead of a gas bubble.  We remove this oil at a later date, which requires a second vitrectomy.
• With a gas or oil bubble in the eye we may ask you to place your head in a specific position for up to 7 days after the operation (for example, face down with left cheek to pillow). This is called ‘posturing’.  It allows the gas bubble to press the retina into position while the eye heals.
• Usually we will ask you to use this head position for 45 minutes out of every hour during the daytime. During the 15 minutes out of every hour when you are not posturing, it is important that you move around to relieve discomfort. 
• We give you advice on posturing before we discharge you home from hospital.

Scleral buckle

A scleral buckle usually takes 1 to 2 hours, but this varies depending on complexity. (Scleral means relating to the sclera, which is the white part of the eye).

A scleral buckle involves the following.

• We perform it while you are under general anaesthetic (asleep).
• We stitch a piece of silicone rubber or sponge (scleral buckle) to the wall of your eye.
• This causes an indentation (dent) of the eyeball, which pushes the outer wall of the eye towards the retinal hole or tear and allows it to close.
• The buckle is not on the outside of the eye and remains in place permanently. You will not be able to feel it.

Why we recommend surgery for you

We recommend this surgery to reattach your retina and prevent loss of vision.

If you have a large retinal detachment where you have lost most of your vision, surgery will still improve vision, but you may not regain normal vision.

After the operation

After the operation you can expect the following.

• You may experience mild discomfort, which you can relieve with over-the-counter painkillers.
• The white of your eye will look red and your eyelid may be swollen.
• You may have a watery eye and a gritty sensation while the stitches used during the operation gradually dissolve. This can take a few weeks.
• Your vision is likely to be blurry for the first few weeks but will slowly improve.
• Your eye is likely to take 2 to 6 weeks to settle down.
• We will give you eye drops to use for at least 4 weeks following your operation.  These will help to reduce inflammation and prevent infection.
• Sometimes we prescribe additional drops or tablets to keep the eye pressure within normal limits.

Everyday activities after surgery

After your surgery, we strongly advise you to follow these guidelines.

• If we give you posturing instructions, you must follow them.
• You can have a bath or shower but try to avoid splashing water near the eye.
• Avoid swimming and contact sports for 4 weeks.
• Most people choose not to drive for the first few weeks. While there is gas in the eye, your vision will be poor, and this will affect your ability to judge distances.
• Most people need at least 2 weeks off work after surgery. This may vary depending on the kind of work you do and the type of surgery that we perform. 
• You must inform the anaesthetist that you have a gas bubble in the eye if you require a general anaesthetic for other operations.

Risks

Retinal detachment surgery is not always successful. 1 in 10 people (10%) will need more than one operation.

Risks include the following.

• Inflammation or bleeding of the eye.
• Raised eye pressure which can lead to damage to the optic nerve (glaucoma) and vision loss.
• Serious infection of the eye (endophthalmitis).  This is rare (it affects fewer than 1 in 1000 patients), but it can cause blindness. [link to leaflet]
• Cataract (clouding of the lens of the eye).  After a vitrectomy, patients often develop a cataract at an earlier age than they otherwise would.  This usually happens within 1 to 2 years of the vitrectomy. If the cataract is affecting your vision, we may need to perform a cataract operation. [link to this leaflet]