The retina is a thin layer of light-sensitive nerve cells lining the back of the eye. Retinal detachment occurs when this neurosensory layer peels away from the underlying tissue that provides it with oxygen and nutrients. This separation prevents retinal cells from functioning properly, leading to blurred vision and a shadow or curtain moving across the field of vision. A detached retina is a serious medical event that requires immediate surgical intervention to prevent permanent vision loss or blindness.
Pre-Surgical Evaluation and Planning
Preparation for retinal detachment surgery begins with a thorough diagnostic evaluation to determine the precise nature and extent of the detachment. An ophthalmologist performs an indirect ophthalmoscopy, using a light and a magnifying lens to view the back of the eye and locate any retinal tears or breaks. If the view is obscured by blood or a cloudy lens, an ocular ultrasound may be used to visualize the retina and confirm the diagnosis.
The surgeon uses these findings to assess factors such as the type of detachment, the number and location of tears, and whether the macula—the center of the retina responsible for sharp, central vision—is involved. This information selects the most appropriate surgical technique. Logistical preparation involves instructions like fasting and reviewing current medications. Anesthesia consultation also takes place, as the procedure may use local anesthesia with sedation or general anesthesia, depending on complexity.
Types of Retinal Detachment Repair Procedures
Surgical repair focuses on reattaching the neurosensory layer and sealing the break that allowed fluid to pass underneath. The choice of procedure is highly individualized, based on the specific characteristics of the detachment. Modern techniques range from less invasive options to more complex operations.
Pneumatic Retinopexy (PR)
Pneumatic retinopexy is a less invasive, often outpatient procedure used for simpler detachments with a single break located in the upper portion of the retina. The surgeon first uses a freezing probe (cryopexy) or a laser to seal the edges of the retinal break. A small gas bubble is then injected into the vitreous cavity of the eye.
The gas bubble floats upward, acting as a temporary internal splint or “tamponade” to push the detached retina back against the eye wall. This technique relies heavily on specific patient positioning post-procedure to ensure the bubble remains in contact with the tear until the surrounding seal heals.
Scleral Buckle (SB)
Scleral buckling involves placing a flexible band, made of silicone sponge or rubber, onto the outside of the eyeball (the sclera). This element is sewn securely to the eye wall and typically remains in place permanently. The buckle gently indents the eye wall inward, pushing the underlying layers closer to the detached retina.
This inward pressure relieves the pulling force, or traction, that the vitreous humor may be exerting on the retina. Cryopexy or laser treatment is used to induce a scar around the retinal break, creating a permanent seal to hold the retina in place. Scleral buckling is often preferred for younger patients or those with simpler detachments, and it can be used in combination with other procedures.
Vitrectomy (PPV)
A pars plana vitrectomy is a more involved surgical procedure often recommended for complex, large, or recurrent detachments, or those involving significant scar tissue. The operation involves making tiny incisions in the sclera to access the eye’s interior. The surgeon uses specialized micro-instruments to carefully remove the vitreous gel, the clear, jelly-like substance that fills the eye’s center.
Removing the vitreous relieves the traction causing the detachment. Any scar tissue is removed, and the retinal tears are sealed with laser or freezing treatment. The empty space is then filled with a substitute material, typically a gas bubble or silicone oil, which serves as an internal tamponade to hold the retina flat while it heals.
Post-Operative Care and Recovery Timeline
The patient’s active participation in post-operative care is crucial for the success of the reattachment procedure. For any surgery involving a gas or oil injection, maintaining specific head positioning is mandatory, sometimes for several days or weeks. This positioning ensures the internal bubble floats against the repaired area, providing continuous pressure to promote healing.
Activity restrictions are put in place to prevent stress on the healing eye, including avoiding heavy lifting, strenuous activity, and bending over for up to four weeks. Patients must also avoid air travel or rapid changes in altitude while a gas bubble is present, as pressure changes can cause the bubble to expand dangerously. Prescription eye drops are used multiple times a day to prevent infection and manage inflammation.
Vision is typically blurry immediately after surgery, and the eye may be red, swollen, and uncomfortable for several weeks. If a gas bubble was used, the patient will see a dark line or shadow that gradually shrinks and disappears as the body absorbs the gas over several weeks or months. Final visual recovery is a gradual process that can take many months, depending heavily on whether the macula was detached and for how long.
Surgical Outcomes and Potential Risks
Modern retinal detachment surgery has a high initial success rate, with the retina being reattached after a single operation in approximately 80% to 90% of cases. The prognosis for final visual acuity is better if the macula was not detached before the surgery. Even with a successful anatomical reattachment, the final visual outcome may not return to pre-detachment levels.
Common risks after surgery include the development of a cataract, a particular concern after vitrectomy, and temporary increases in eye pressure (glaucoma). Patients may also experience temporary discomfort, redness, and a gritty sensation. More serious, though less frequent, complications include infection, bleeding, and the need for a follow-up operation.
The most common reason for surgical failure is the recurrence of detachment, often due to the formation of scar tissue called proliferative vitreoretinopathy (PVR). PVR is a risk factor for poorer visual outcomes and may necessitate multiple subsequent procedures to achieve a stable result. If silicone oil was used as a tamponade, a second operation is required months later to remove the oil once the retina has fully healed.