If retinal detachment has occurred, surgery is required to reattach the retina.
Without treatment, total loss of vision is almost certain. In 90% of cases, only one operation is needed to reattach the retina.
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 the 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 different surgical treatments for a detached retina are explained below.
If the detachment is relatively small and uncomplicated, a procedure called pneumatic retinopexy may be used. This involves injecting a small bubble of gas into the eye, which presses the retina back into place.
Laser or freezing treatment is often then used to create scar tissue that keeps the retina in the correct place. The bubble is slowly absorbed into the eye over the following weeks.
After the procedure, you will be asked to keep your head in a certain position for a while, known as "posturing", so the bubble settles in the correct position.
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 that requires general anaesthetic, you must tell your doctors about the gas bubble in your eye.
Scleral buckling involves fine bands of silicone rubber or sponge that 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, 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 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.
As with a pneumatic retinopexy, posturing will be necessary to ensure the bubble is in the right place. The same restrictions on flying and precautions for further surgery that apply to pneumatic retinopexy also apply to vitrectomy.
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.
Read about recovering from retinal detachment surgery.