Retinal detachment surgery

The retina is a thin layer of light-sensitive cells that lines the inside of the eyeball. It is essential for the perception of images, colors, and spatial perception.

Redinal detachment types

The most common type of detachment is a retinal tear, which is caused by holes or tears in the retina. These tears occur when the vitreous, a jelly-like substance that fills the cavity of the eyeball, tears, causing fluid to leak through the holes under the retina and pull it away. The tear disrupts the function of the retina and, if left untreated, can lead to partial or complete loss of vision. 

This process is usually the result of age-related changes in the eye and is not caused by any activity, although it can be caused after an eye injury. In some cases, the likelihood of detachment is increased, such as in people with myopia, if there has been a previous cataract removal operation, and if there is a family history of detachments.

Another type of detachment is tractional, which is caused when membranes of various origins pull on the retina and detach it from its substrate. The most common cause is diabetic retinopathy, which is damage to the eye caused by diabetes mellitus.

Finally, a less common type is serous detachment, where fluid leakage from the vessels, such as in certain types of inflammation, causes the layers to separate and the retina to detach.

Treament

The treatment of the first two types is surgical, while the latter requires treatment of the underlying cause with or without surgery.

Surgical techniques

1. Vitrectomy, cryocoagulation and gas or silicone oil injection

Vitrectomy is a minimally invasive procedure in which the surgeon inserts instruments into the interior of the eye through microscopic incisions in the sclera ("white of the eye") for surgical procedures. The vitreous is removed and the cracks that caused the detachment and/or any traction membranes are identified. These are then treated with cryosurgery or laser. This causes the formation of a scar reaction, which stabilizes the cracks after about a week. 

A bubble of gas or silicone oil is then inserted, which stabilizes the retina until the scarring reaction forms. If gas is used, it remains in the eye for up to 12 weeks, depending on the type of gas used. The gas is naturally absorbed over time and is replaced by fluid produced by the eye. As long as gas remains in the eye, flying, diving, or staying at high altitudes are not permitted. Silicone oil is not prohibited for airplane travel. However, it is not absorbed automatically and a second, shorter procedure will be required to remove it. Depending on the location of the lesions in the eye, you will be asked to hold your head in a specific position for a certain period of time.

In most cases (80%) retinal detachment is repaired with one operation. In a small percentage, and especially in complicated or neglected cases, more than one operation may be required.

Vitrectomy is a widely used and safe method for retinal detachment. If you have not undergone cataract surgery, vitrectomy may cause the lens to become cloudy or develop more rapidly, requiring cataract surgery within 3 months to 2 years of the initial retinal surgery.

In some cases, a transient increase in intraocular pressure may occur, which may require medication for a certain period of time. The eye pressure will be measured during the postoperative check-up and your doctor will inform you of a possible change in your treatment.

Endophthalmitis or eye infection is a potentially serious but rare complication of any eye surgery. The surgical team follows strict protocols of hygienic antisepsis and sterilization throughout your stay with us in order to minimize the possibility of this complication. We recommend that you closely follow the postoperative instructions that will be given to you and the correct use of the treatment that we will provide you.

Other potential complications of the procedure include bleeding, scarring, dry eyes, local irritation, and image distortion. If you experience any of these, your doctor will discuss treatment options and recovery time with you.

 

2. Cryocoagulation and silicone implant.

In this technique, after cryocoagulation is applied to the tear or tears that caused the detachment, a silicone implant is placed on the outside of the eye under the eye muscles, which presses the wall to reattach the retina. This allows the fluid that has detached the retina to be absorbed and the anatomical integrity of the retina to be restored.

If the detachment persists, it may be necessary to repeat the procedure or use a different technique.

 The implant can remain in the eye for life without any problems. In a small percentage it can cause diplopia “double vision”. In most cases the symptoms resolve spontaneously within a few weeks. In a very small number of patients inflammation or infection may occur in the area of ​​the implant, which usually resolves with medication. In a very small percentage the implant may need to be removed.

Pneumatic retinopexy

In a selected number of cases, it is possible to apply a minimally invasive method where, after cryosurgery is applied to seal the cracks, a gas bubble is injected to plug the area of ​​the detachment. This method has positive results in small detachments. Complications are similar to those of vitrectomy but occur much less frequently.