Repair of Retinal Detachment with Scleral Buckling
What is retinal detachment?
Normally the retina is firmly attached to the back of the eyeball. If it becomes detached, the eye loses vision.
This is a rare disease occurring in about one person out of 10,000, each year. The immediate cause is usually a hole in the retina. It may be due to injury or surgery, but is usually due to weakness of the retina. This is sometimes called degeneration.
What is scleral buckling surgery?
The surgery may be done under general anaesthesia (you will be sound asleep) or local anaesthesia (you will be awake but an injection will prevent any pain). The retina is reattached by freezing (cryosurgery) and with the placement of a permanent silicon patch (buckle) on the wall of your eyeball.
The external stitches will melt away and do not have to be removed. Usually the eye responds to one operation; occasionally, additional surgery may be required. The eyelashes are cut before surgery but they always grow back.
You will probably spend one or two nights in the hospital after the operation. Normally, only the operated eye is bandaged but, sometimes, both eyes may be bandaged for a few days. Most patients can return to work in four to five weeks.
What may I do after surgery? You must stay at home for at least three weeks, traveling should be avoided except to visit the doctor. After surgery you will be given written instructions regarding medication and precautions to be taken. You should carefully observe these instructions. You may be advised to lie on your side or stomach while sleeping or resting.
What are the chances of success?
In most cases (85%) the retina can be reattached with a single operation. Occasionally additional surgery is necessary; this brings the final cure rate up to approximately 95%. The final degree of clarity of vision will not be known for three months. If you had lost your reading vision before surgery, you should find considerable improvement but probably not 100%. If your reading vision was not lost before surgery, good vision will be retained (after convalescence) in more than 90% cases. In 5% cases the retina may not re-attach, necessitating further surgery.
What are the common side effects and complications of the surgery?
Your vision will be blurred. The eye will be painful, red and swollen and there may be some mucus discharge. The pupil will be large and you may see double. These side effects are usually temporary and last only a few weeks. In many cases the eye will become more near-sighted; this can be corrected with spectacles.
Over 90% cases have no significant complications. Occasional problems include bleeding or infection or re-detachment. Very rarely such complications could lead to the loss of all vision. Anaesthesia-related complications are also rare; the anesthetist will discuss these with you.
What about the future of my retina?
If the retina remains attached for three months after surgery, the chance of recurrence is only 10%. If the retina of your other eye appears normal at this time, the chance of developing a detachment later on is approximately 12% in the eye that has not been operated.
Can retinal detachment be prevented?
In some cases the retina is more fragile and prone to formation of holes or breaks. If these are detected and sealed in the early stages by laser or cryosurgery, retinal detachment can be prevented. People who are likely to develop retinal detachment should have periodic examinations done after dilation of the pupils. Some of the situations where this is desirable are:
History of detachment in one eye
Family history of retinal detachment
History of injury to the eye or its surrounding bones
History of flashes and floaters
Sudden onset of floaters or change in the character of floaters
Surgery of the Interior of the Eyeball with Vitrectomy
What is Vitrectomy?
This is a very delicate operation performed with an operating microscope and special needle-sized instruments.
The most common indication for this operation is removal of the vitreous, which has lost its transparency and, therefore, has become an obstacle to the incoming light.
In this surgery most of the non-transparent vitreous is removed and replaced with a clear solution.
Vitrectomy may also be used to remove the pulling forces of the vitreous, which may have led to detachment of the retina.
This operation may also be used to remove blood clots, infectious material, cataract, foreign bodies, and abnormal membranes from the interior of the eyeball. Sometimes it is done for diagnostic purposes for diseases of unknown origin. Occasionally it may be necessary to inject air, gas, or silicone oil into the eye after removing the vitreous gel.
How is the operation performed?
The surgery may be done under general anesthesia (sound asleep) or under local anesthesia (you are awake but feel no pain).
The operation takes two to four hours. Usually one operation is sufficient, occasionally additional surgery may be required.
The eyelashes are cut but they always grow back. Most patients stay in hospital for one or two days; longer hospitalization may sometimes be necessary.
A face-down position for sleeping may be suggested for several days. The operated eye will be bandaged for one day. Occasionally both eyes may need to be bandaged to ensure complete ocular rest.
What may I do after the operation?
For the first two weeks you should rest at home. T
Traveling should be avoided except to see the doctor. If gas has been injected into the eye, you should avoid air travel for several weeks until specifically authorized by the doctor.
Postoperative instructions will be given to you at the time of discharge and these should be strictly followed. Most patients are able to return to their routine in four weeks.
What are the chances of success?
The vision improves to some degree in 90% of simple vitrectomy cases. In difficult cases however, improvement is seen in approximately 60% of the cases while in others it may remain the same or even decrease.
The final degree of clarity of vision is usually not evident for about three months. How much vision a patient will ultimately have is difficult to predict in individual cases.
Patients are usually able to see large objects but fine vision and reading vision may not improve.
What are the side effects and possible complications of surgery?
Blurred vision, pain in the eye, redness and swelling, mucus discharge and enlarged pupil and double vision are usually the temporary side effects and they clear up in a few weeks.
Usually there are no complications, but some patients may have problems such as recurrent bleeding, infection, or elevated pressure in the eye.
Rarely, a retinal detachment or cataract may develop requiring further surgery, either during or after the vitrectomy operation.
Very rarely a complication may lead to the loss of all vision. To find out about anesthesia related complications, one may consult an anesthetist.
