If retinal detachment has occurred, the only way of re-attaching the retina is with surgery.
Without surgery, total loss of vision is almost certain. In 90% of cases, only one operation is needed to re-attach the retina.
Surgery
Surgery for retinal detachment may be done under a general anaesthetic (where you are put to sleep) or a local anaesthetic (where drops are used to numb your eye and surrounding tissue).
You will be asked not to eat or drink anything for six hours before the operation. Afterwards, you may need to stay in hospital for one or two days, or you may be able to leave on the same day, depending on the circumstances.
Before you are given the anaesthetic, you will be given eye drops to widen your pupil.
The retina is usually re-attached in a procedure using either scleral buckling or vitrectomy. These are explained below.
Scleral buckling
Scleral buckling is the preferred way of re-attaching the retina if it has a tear or hole in it.
Fine bands of silicone rubber or sponge are stitched onto the outside white of the eye (the sclera) in the area where the retina has detached. The bands act like a buckle and press the sclera in towards the middle of the eye, so the torn retina can lie against the wall of the eye.
Laser or freezing treatment is used to scar the tissue around the retina (see the box, right), which creates a seal between the retina and the wall of the eye and closes up the tear or hole.
The bands can be left on the eye and should not be noticeable after the operation.
Vitrectomy
Vitrectomy works by removing the fluid from the inside of the eye and replacing it with either a gas or silicone bubble. This holds the retina in position from the inside.
A vitrectomy may be recommended if the fluid in front of the eye is unusually thick and dense and is pulling the retina away from the underlying blood vessels.
Tiny dissolving stitches are used to close the wound. It is also possible to perform such surgery without the use of stitches, using smaller instruments. While this may lead to less discomfort, it is not known whether it is more effective.
After the procedure, you will be asked to keep your head in a certain position for a while, known as "posturing", so the bubble lies against the retina.
If you have had a gas bubble put in your eye, you will not be able to travel by air for a while. Your doctor will tell you when it is safe to fly again. If you need another operation requiring general anaesthetic, you must tell your doctors about the gas bubble in your eye.
Possible complications
There is a small chance of developing complications during or after surgery, including:
- bleeding inside the eye
- more holes in the retina
- bruising around the eye
- high pressure or swelling inside the eye (glaucoma)
- the lens of the eye becomes cloudy (cataract)
- double vision
- allergy to the medicine used
- infection in the eye (this is very rare)
These complications are not common and can usually be treated. Sometimes you may need more than one operation to fix the retina.
