Retinal Detachment

retina is the light sensitive tissue at the back of the eye. Human retina is made up of 10 layers. The outermost layer is the most sensitive layer made of special types of cells known as photoreceptors ( rods and cones). When this outermost layer separates from the remaining 9 inner layers then it is known as RETINAL DETACHMENT. There can be multiple risk factors like –

1. Posterior vitreous detachment – in this the jelly like substance between the lens of the eye and retina known as vitreous, separates from few areas of the retina. Normally vitreous is strongly attached to the retina at multiple points.

2. Any severe injury to the eye like with cricket ball, fist injury etc

3. High myopia

4. Lattices with holes – these are areas of weakness in retina which sometimes predispose to retinal detachment

5. Diabetic retinopathy

6. Family history

7. Complications of cataract surgery

The patient usually has symptoms of flashes and floaters which is followed by loss of vision which is usually sudden and marked.

The retinal detachment surgery can be of following types-

1. SCLERAL BUCKLING – in this type of surgery, a special type of band, usually made of silicone ( scleral buckle) is applied all around the eye or in the area of the detachment underneath the superficial layer of the eyeball (conjunctiva).this buckle pushes the outer layers of the eyeball against the retina providing a tamponade and helps in flattening the retina. The fluid inside the retina causing retinal detachment is removed by making external opening in the eye and this opening is then sealed by applying extreme cold spots known as cryopexy, or heat ( diathermy) or by laser photocoagulation. The buckle is usually left permanently and is sewn in its place with the external layer of the eyeball ( sclera).

This procedure usually takes 1.5 to 2.5 hours depending upon the severity of the detachment.it is an outpatient procedure and usually hospitalization is not required.

The vision is usually blurred after surgery. There may be redness in the eye and pain may also be present. However, regular medications and taking proper precautions may alleviate some of these problems.

The precautions to be taken after the surgery are-

1. Proper positioning may sometimes be needed to be maintained as advised by the doctor.

2. Avoid travelling, especially air travel

3. Avoid lifting heavy weights or doing strenuous exercises

4. Avoid rapid eye movements

5. Avoid splashing water into your eyes for at least 3 weeks after surgery

6. Take regular medications

This procedure however has its own complications which may present despite taking adequate precautions during surgery

1. Re detachment of retina. This usually occurs due to proliferative vitreoretinopathy (bands form on the surface of retina and pull it and not let it flatten)

2. Bleeding inside the eye

3. Infection

4. Migration/ extrusion of the buckle implant

5. Increased near sightedness

6. Increase in the pressure of the eye Most of these are treatable. However, re detachment due to PVR may be difficult to treat.

7. PNEUMATIC RETINOPEXY- In certain types of retinal detachment, a gas bubble ( C3F8) is injected inside the eye. This gas bubble presses against the detached retina providing a tamponade and flattening it. The retinal tear is then sealed by freezing (cryopexy) or by Laser photocoagulation).

It is a regular office procedure for which hospitalization is not required. it takes around 15 to 30 minutes. However, after this proper positioning has to be maintained as advised by the doctor or else the retina would not attach.

There is usually a decrease in vision after surgery due to the gas bubble and it improves in 1 to 3 weeks when the gas bubble is reabsorbed.

The precautions to be taken are –

1. Avoid travelling especially air travel or going to hill stations

2. Maintain proper positioning

3. Take medications regularly

The complications of the surgery are the following –

1. Increase in the pressure of the eye

2. Migration of fluid into the macula causing macular detachment

3. Re detachment

3.PARS PLANA VITRECTOMY – this pertains to removal of the vitreous gel in the eye, which is located between the lens and the retina. Then the retinal hole is located after flattening the retina. This hole is sealed by a laser which causes scarring and hence the retina surrounding the hole adheres to the underlying layer. Then silicone oil or gas ( c3f8) is injected into the vitreous cavity which provides tamponade and hence helps in flattening the retina and causes its adherence with the underlying layers.

It is an outpatient surgery performed under local anaesthesia ( blocks). Usual duration is 1 to 3 hours. Patients can go home after a short monitoring period.

Patients may have some pain after the surgery for a few days which gradually resolves with medications. The vision may be blurred for 2 to 4 weeks. If gas is injected then it usually resorbs in 2 to 3 weeks and the patient’s vision gets better. However if Silicone oil is put then the patient may take a longer time. Also, silicone oil has to be removed after 3 months of surgery.

Patient may have to avoid general activities like driving, reading and exercises for a few weeks.

Also avoid lifting heavy weights and rapid eye movements.

Patients may have to lie face down for a few weeks as advised by the doctor.

Complications of vitrectomy are –

Cataract
Glaucoma
Corneal haze and decompensation
Silicone oil bubbles anteriorly in the eye
Re detachment

Vitrectomy done for macular hole, vitreous haemorrhage and early stage retinal detachment usually has a very good prognosis and patients usually gain good vision few weeks after the surgery

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FAQs

Is vitrectomy a major surgery?

Yes, it is a major surgery but is an outpatient procedure and patients can go home after being monitored for a short time.

Does vitrectomy improve vision ?

In cases of vitreous hemorrhage where vitreous has been clouded with blood, it does improve vision. Also, patients regain good vision in vitrectomies done for early stage retinal detachment and early stages of macular hole.

How successful is vitrectomy?

The success rate is around 80-90% in good prognosis cases.

How long does it take to clear vision after vitrectomy ?

It usually takes 2 to 4 weeks for the vision to improve however it may take long depending on an individual.

Why Do I have poor vision after vitrectomy?

In vitrectomy usually gas or silicone oil is injected to flatten the retina. Due to this the media clarity is compromised and patients have blurry vision. This usually improves over 2 to 4 weeks. However, there may also be formation of cataract after vitrectomy which can cause clouding of vision. Development of glaucoma, especially in cases of silicone oil can also compromise vision.

Why do cataracts develop after vitrectomy ?

Vitreous acts as a protective barrier and prevents more of the oxygen reaching the lens. However when it is removed then more of the oxygen circulates in the posterior chamber and reaches the lens and leads to the formation of nuclear sclerotic type of cataract.

How do you sleep after vitrectomy?

You may have to sleep face down for a few days or position yourself according to the advice of the doctor.

What should I do after vitrectomy?

You should take proper rest and give time to your eyes to heal.

Also you might have to maintain a proper positioning according to the advise of the doctor for 1 to 3 weeks

What can you not do after vitrectomy?

Avoid driving, reading, exercises, lifting heavy weights and rapid eye movements for a few weeks after surgery.

What is vision like after vitrectomy?

There may be swelling and redness in your eyes which usually subsides 1 to 2 weeks with medications. There may be blurring of vision which usually becomes better in 2 to 4 weeks.

How quickly do cataracts develop after vitrectomy?

It usually takes a few months to a few years after your initial retina surgery.

Can I sleep on my side after the vitrectomy ?

You might be asked to sleep on one side or face down for a few days after the surgery.

Can you see after vitrectomy?

If the pathology has caused permanent damage to the retina then it might be difficult to restore complete vision.

How long does vitrectomy surgery take ?

Vitrectomy may take 1 to 3 hours depending on the problem of the patient.

Does vitreous regenerate after vitrectomy?

No vitreous doesn’t regenerate. The vitreous cavity is filled by a fluid like substance.

How long after vitrectomy can I drive?

It is not safe to drive after the vitrectomy and may take a few to several weeks.

Are you awake during vitrectomy?

It is usually performed under local anesthesia and the patient is sedated. Patient is usually awake but doesn’t feel the pain or see the surgery being done.

Is scleral buckle permanent?

Scleral buckle is usually permanent. However in a few cases, temporary buckle may be used.

How long does scleral buckle last ?

Usually a good anatomical success rate is achieved by scleral buckling , however the rate of redetachment is highest in the first year ( may be 47%) due to unsupported tears, missed breaks, inadequate buckle or inadequate retinopexy. In that case repeat surgery may have to be performed.

How successful is scleral buckle surgery?

The overall success rate ( according to studies ) is around 85% for primary surgery and around 96% for secondary surgery after one initial surgery.

Can scleral buckle be removed?

The removal of the scleral buckle carries a high risk of retinal re detachment. However , it has to be removed in cases of infection, implant migration or extrusion.

Can you see the scleral buckle?

Usually it is covered by the conjunctiva and not visible on the outside. However, it becomes visible when it migrates outside ( extrusion).

Is Scleral buckle painful?

There may be some pain in the immediate postoperative period following Scleral buckle surgery. However, this pain usually subsides with medication in one month in a majority of patients.

Can you have MRI with the scleral buckle?

Yes. It is usually safe to have MRI with scleral buckle especially after the use of Tantalum clips.

Does scleral buckle have metal in it ?

Scleral buckle is made of silicone which is non metallic. Initially metal clips were used to secure the buckle but now they are rarely used.

Can you wear contact lenses after buckling?

Preferably after 6 months of surgery, vision is tested once the vision changes become stable. Thereafter new number is prescribed and glasses or contact lenses can be worn accordingly.

Can scleral buckle cause astigmatism?

It can cause some increase in astigmatism.

How is scleral buckle done?

In scleral buckling, a silicone buckle is sewn onto the sclera at the location of the retinal tear. This provides an external tamponade and pushes the retina and causes its attachment.

Can you watch TV after retinal detachment surgery?

There is no harm in watching TV after surgery. However, there may be blurring and slight distortion of vision which may make it slightly difficult to watch TV.

Can you fly after scleral buckle surgery?

It’s safe to fly after scleral buckle surgery.

What is the cost of scleral buckle surgery?

The cost of scleral buckle surgery is approximately 2500$ – 3500$ depending on the severity of the retinal detachment.

What is the cost of vitrectomy?

The cost of vitrectomy is also around 2500$- 3500$.

Is retinal tear an emergency?

Yes, Retinal tear is an emergency. It leads to retinal detachment. The longer the retina is detached, the more there are chances of permanent damage.

How long does pneumatic retinopexy take ?

In pneumatic retinopexy, a gas bubble is injected which provides a tamponade to the retina and pushes it against the sclera and causes its attachment. This gas bubble usually resorbs in 3 weeks.

How long does it take after for the gas bubble to go away after the retinal surgery?

When air is injected, it resorbs in 1 week. When SF6 gas is injected then it goes away in 4 weeks. C3F8 gas takes around 8 weeks to go away.

Is pneumatic retinopexy painful?

The procedure is performed under topical anesthesia and usually there is no pain. However there may be some pain after the surgery for which medications are prescribed.

What is pneumatic retinopexy?

It is an outpatient procedure in which for the certain types of retinal detachment are treated by injecting a gas bubble inside the eye. This procedure is done under local anesthesia.

How do you sleep after retinal tear surgery?

After surgery, a particular position has to be maintained, like lying face down or propped up or on one side, depending on the site of the retinal tear. This position has to be maintained for a few days in accordance with the advice of the doctor.

How many days face down after vitrectomy?

Usually you have to sleep face down for 14 days after macular hole surgery. For other vitrectomies, usually this is for 5 days.

When can I return to work after retinal detachment surgery?

Usually after retinal detachment surgery, it takes around 2 to 3 weeks to return to work. However strenuous activities should be avoided. After laser retinopexy, normal activities can be resumed in a few days.

What is Laser retinopexy?

It is an office procedure in which Laser is used to seal the retinal tear to prevent the formation of retinal detachment. There might be some blurring for vision for sometime ( around 30 minutes)

What is the cost of pneumatic retinopexy?

The cost of pneumatic retinopexy is around 1500 $.

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