Treatment of Retinal Detachments

Timing of repair

Once the retina has detached, it is important to undergo treatment urgently to re-attach the retina. The reason for this is that after the retina has separated from the eye wall, it soon begins to undergo permanent structural changes that can reduce the chances for the best recovery of vision. Treatment is typically recommended either immediately or within several days, depending on the circumstance and type of detachment. In some cases, it is safe to delay treatment by up to a week or more without a significant concern that the delay will result in any difference in outcome. In other cases, the repair needs to be performed as urgently as possible. Retinal detachments are like fingerprints in that each one is different, and your physician will discuss the considerations around your situation on a case-by-case basis.

Treatment of Retinal Detachments

In some cases, retinal detachments can be very effectively managed without traditional surgery by means of an in-office procedure using laser treatment with or without an injection of a specialized gas into the eye, a treatment called pneumatic retinopexy. The advantage of this is avoidance of the somewhat greater risk of traditional surgery, along with much improved patient comfort and easier recovery.

In many cases, traditional surgery is a better option and will be recommended. Surgery for retinal detachment involves two types of procedures, vitrectomy and scleral buckling. These procedures require a trip to the hospital and are performed by our physicians with the patient asleep under general anesthesia. Typically, the patient is able to go home following surgery and is seen in follow-up the next morning. In vitrectomy surgery, the general concept is that the vitreous gel inside the eye is first removed so as to eliminate its ability to pull on the retina. Once this is accomplished, the retina can be re-attached using numerous techniques with specialty gases, fluids and laser treatment. Scleral buckle surgery involves placing a silicone band around the eye which also serves to reduce the vitreous traction on the retina. Some patients require both a vitrectomy and scleral buckle procedure be performed at the same time for the optimal outcome.

Recovery and Prognosis

The recovery from retinal detachment surgery is variable and depends on the type of procedure performed. If intraocular gas is used, it will usually be essential for the patient to keep his or her head in a certain position for several days following surgery. This can be challenging, but is critical to the success of surgery. Additionally, airplane travel is not permitted during recovery due to the effect of altitude on the intraocular gas. In general, patients can expect to see recovery of vision beginning anywhere from 2-6 weeks following surgery if healing proceeds normally. The extent of vision recovery is also highly variable and depends on the extent of the initial detachment and how long the detachment had been present. Around 5% of patients will develop an abnormal scar tissue reaction following surgery which can cause recurrence of the detachment and usually necessitates further intervention.