In early stages,  small amounts of retinal detachment can be treated by laser in the office, or occasionally by another technique, cryotherapy. This is the use of a supercooled probe, placed against the outside of the eye, to achieve a bond of the retina to the underlying tissues. Laser achieves the same effect by heat energy. For many retinal detachments however, surgery will be needed. There are a number of different operations used in this context and sometimes more than one operation is required. Many people can have retinal detachment treated by vitrectomy surgery. 

Grey, detached retina seen as undulating folds in lower half of photograph. Like a plastic bag in a bucket of water

Victrectomy Surgery

In this technique small instruments are used inside the eye to remove the vitreous gel. Once removed, the fluid that has accumulated from underneath the retina can be drained away and the retinal tears sealed with either laser or cryotherapy. Finally, a long lasting gas is injected into the eye. This gas holds the retina in place whilst healing occurs. The gas dissolves after varying periods. Whilst the gas is in the eye it usually blocks vision quite substantially. In addition a person with gas in their eye may not travel to high altitude like the Blue Mountains, nor may they fly. Vitrectomy with gas injection may also cause cataract to form in some eyes. Frequently the pressure of the eye may need to be controlled.

Sometimes it becomes necessary to do another or additional procedure called scleral buckling.

In this technique a silicone strap is placed around the eye and tightened slightly. It alleviates the pulling forces on the retina and allows the retina to remain attached. Cryotherapy is used once fluid under the retina has been drained away. Occasionally small gas bubbles are injected to help reattach the retina. The strap stays on the eye permanently like a splint. It is not visible nor is it felt by the patient. Scleral buckling possibly has a slightly higher rate of maintaining retinal reattachment than vitrectomy alone but typically it also results in the eye becoming more short sighted than it was before. Vitrectomy and scleral buckling are often combined. Typically, an eye that has had a scleral buckle will be quite red and sore for a while and it may take up to 2-3 months for the eye to appear normal from the outside.

Some retinal detachments can be more severe. In these, scar tissue forms on the surface of the detached retina, tangling the retina. The surgeon will then need to dissect the scar tissue and apply laser, and do a scleral buckle. The eye will then be filled with gas or with liquid silicone, silicone oil. The silicone will be left inside the eye for periods up to 12 months but fortunately it is possible to see through it. Occasionally other special liquids are used either during or after surgery to help in reattaching the retina.

The main problem with retinal reattachment surgery is the risk of redetachment. Risks vary depending on the type of detachment. Overall, there is roughly a 95% chance of reattaching a retina with one operation but for more severe detachments this figure reduces sharply. There are occasional eyes in which even multiple operations do not result in a reattached retina.

For further information contact Sydney Eye Doctors, call Sydney +61 2 92334840