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Retinal Detachment

Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nutrients.

The retina is the light sensitive tissue at the back of they eye which allows us to see.

When one has a retinal detachment, often a black curtain can be noticed somewhere in the peripheral vision of one eye.  Sometimes, when it is very small, the curtain is not noticed, and patients will simply have many floaters and flashing lights.

It is best to treat a retinal detachment when the central vision, provided by the macula area of the retina, is intact; this type of detachment is termed a “Macula-on Retinal Detachment”. Once the central vision is affected it is termed “Macula-off”; once the central vision is affected, surgery is less urgent and typically done within one or two weeks.


Surgical repair is necessary to fix all types of retinal detachments. Dr. Adatia will choose the technique based on the location of the tear, the complexity of the detachment and the age of the patient.


Briefly described here are three common techniques: vitrectomy, scleral buckling and pneumatic retinopexy.


1. Vitrectomy

Vitrectomy is the most common technique for surgical repair of retinal detachments.  It involves making three small ports in the eye.  These ports are so small that they usually do not require any stitches to close as they self-seal.  One port is for an infusion fluid to keep the eye pressure, while the other ports are used to introduce a light and a cutter.  The light allows the surgeon to see into the inside of the eye through a microscope.  The cutter is used to remove the vitreous jelly which is pulling on the retina.  Removal of the vitreous allows the retina to lie back down in place.  Often, we will use heavy liquid which works almost like a paperweight to hold the retina in position.  Once the retina is back in position, laser or a freezing technique called cryopexy is used to seal the retinal tear or hole which caused the retinal detachment.  Gas is then used to help keep the retina in position while the laser or freeze treated area heals to full strength. With gas in the eye, patients can often only see movement. This is normal. It is like looking through a fishbowl in that light is bent differently with gas in the eye. Often patients need to keep their head down for a period of time after retinal detachment repair; this is to keep this gas bubble in the correct spot.  Sometimes oil is placed in the eye instead of gas for various reasons.

Complications of vitrectomy include: a 1 in 1,000 risk of bleeding or infection, a 10-20% chance for re-detachment, and a high risk of cataract should one not have already had cataract surgery.  Cataract surgery can always be done in the future should this occur.  Cataract surgery is the most common of all performed surgeries.  Sometimes the pressure can be high or low right after the surgery.  If it is high, drops can be used to treat it.  Low pressure usually will resolve on its own.  With gas in the eye, patients must avoid elevations as the gas can expand and block the circulation in the eye which is very painful and can lead to blindness.  Overall, this is a very safe and common procedure.


Dr. Adatia will speak to you about your individual risk when consenting you for surgery.


2. Scleral Buckling


This technique involves inserting a hidden silicone band around the eye to help bring the eye wall against the wallpaper or retina.  Laser or freezing is used to treat the retinal break. The band is hidden behind the muscles of the eye and typically stays in forever.

This technique is frequently used in younger patients as it has the benefit of reducing the risk of cataract as a surgical complication.  It can also be used in addition to vitrectomy in retinal detachments with scarring or those with inferior or extensive pathology.

Complications include: a 1 in 1,000 risk of bleeding or infection, a 10-20% chance for re-detachment, post-operative discomfort which lasts for a few days, a chance of double vision which is usually rare and transient.


Dr. Adatia will speak to you about your individual risk when consenting you for surgery.


3. Pneumatic Retinopexy


This technique involves injecting a gas bubble into the eye to push the retina back into the right position; the tear which caused the retinal detachment is then sealed in place with laser or a freezing treatment.  This can be done in the office or the hospital.  It has the best chance of success in select cases where the detachment involves small tears or breaks in the retina and are located in specific areas, and in patients who have not had cataract surgery.  However, it can be successful in other circumstances.

After the injection, the surgeon may have you position your head in specific ways to ensure that the gas bubble floats and presses against the detached area. This positioning helps the gas bubble push the retina into place, allowing the tear or break to heal and reattach.

The gas bubble will slowly dissolve on its own over time. As it dissolves, your body will gradually replace it with natural eye fluids. During this process, the retina should heal and reattach to the back of the eye.

This technique has less of a success rate than vitrectomy or scleral buckling.  Typically, up to an 80% success rate can be obtained in well chosen cases.  It also often requires more visits in the short term.  However, it can avoid having to go to the operating room and operations can still be done if this technique is unsuccessful. Positioning is most important for success in this technique.

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