This leaflet aims to give you some general information about the treatment and aftercare of this condition.
The Retina
The retina is the light sensitive layer at the back of the eye (film) which transmits the messages of the light rays along the optic nerve to the brain. Light rays enter the eye through the transparent (clear) cornea then pass through the pupil in the centre of the iris (coloured part of the eye) and onwards through the lens and vitreous (a jelly-like substance) before reaching the retina.
Retinal Detachment
If the retina separates from the underlying inner wall of the eye, a retinal detachment has occurred. This is similar to wallpaper peeling off a wall. The part that is detached (peeled off) will not work properly. The picture that the brain receives becomes patchy or may be lost completely.
Nearly all retinal detachments develop because of a hole or tear in the retina. This usually occurs when the retina becomes ‘thin’ especially in short sighted people or if the vitreous separates from the retina. Other eye or health problems such as diabetes, after cataract operation and injury such as a blow to the eye can occasionally be the cause of a retinal detachment.
Treatment
Surgery is necessary to “reattach” the retina. Without surgery, vision will almost always be completely lost. Surgery is usually performed under local anaesthesia and occasionally under general anaesthesia. You will usually be admitted as “day case” and stay in hospital for for a few hours after the operation.
There are two main kinds of operations used to reattach the retina.
1.Scleral-buckling:
Pressure can be applied on the retinal detachment from the outside of the white of the eye. Fine bands made of silicone are stitched on to push in against the hole in the retina. These bands are left in place and usually do not cause any trouble.
2.Vitrectomy
More usually an internal approach is used to re-attach the eretina from the inside by removing the vitreous and replacing it with a clear substance (air, gas or silicone oil) by using very fine instruments and an operating microscope. This closes off the break in the retina from the inside. Most procedures can be completed using microincision sutureless techniques. The eye is never removed and replaced when operations are carried out.
If gas is used it will gradually be absorbed and disappear. The time this takes depends on the type and amount of gas inserted. It is replaced naturally by fluid from within the eye. If Silicone oil is used it remains in the eye until or unless a decision is made to remove it by another operation.
The Other eye
Having a retinal detachment in one eye means that you have an increased risk of getting a similar condition in the other eye. It is usual to examine the other eye in detail, so if any weak areas are found they can be preventively treated by laser or cryotherapy (freezing). This greatly reduces the risk of getting a retinal detachment in the other eye. This will usually not affect your vision, but the eye may be sore for a few days after treatment.
Tests before surgery
You may have tests (such as urine test, blood tests and an electrocardiograph ECG) to check you are in good health or if any special measures need to be taken to prepare you for your surgery and during and after surgery.
After the operation
Your operated eye will be covered with an eye pad and protective eye shield for the first night after operation. You may experience some discomfort immediately after the operation. If so, request medicine for pain/sickness relief.
If you have had air, gas or oil inserted into the eye:
- Initially you should not lie on your back as the substance in your eye may float to the front of your eye and away from the retina.
- The nurse looking after you will advise you about movement as you may be asked to “posture”. This is positioning your head in a certain way if you have had bubbles of gas, air or silicone oil injected during the operation. For the first few days you must posture as directed day and night with only 10 minutes break each hour except for meals and hygiene purposes.
When your eye pad is removed your eye may be red and swollen. The eye is then usually left uncovered to promote healing. You will have a pad or shield applied for protection at night and eyedrops will be prescribed.
General Questions
- Will I be able to see properly again?
If the operation to reattach your retina is successful, you will be able to see again but the quality of your vision may not be as good as previously. Gas or silicone fluid in the eye may mean the retina does not function fully immediately after operation and recovery of sight is usually a gradual process.
- What is the success rate of surgery
In most cases, there is better than 80% chance of successfully reattaching the retina with one operation. But successful reattachment does not necessarily mean restored vision. The return of good vision after surgery depends on whether, and for how long, the macula (central part of the retina) was detached prior to surgery. If the macula was detached for a long duration, it is unlikely that vision returns to completely normalnormal. Still, if the retina is successfully reattached, vision usually improves. The best vision is usually not achieved for some weeks to months.
- What should I expect in the postoperative period?
The eye will be red and slightly sore for a few days to a month. Severe pain is uncommon; if it occurs, inform the nurse or doctor immediately. The eye will water for several weeks, and you may find it more comfortable to wear a patch on the operated eye. Eye drops are required for a few weeks. These should be continued till instructed.
- Will I be able to continue with my normal way of life?
Normal activities without any restrictions may be resumed immediately, except initially as dictated by posturing requirements.
- Can I fly after the operation
You should not travel by air if you have had gas injected and the bubble is still present – this period can last upto 8 weeks.
- Are there any complications
As with any major surgery, there is a risk of complications. However it is important to realise that these are generally infrequent. Any one of these complications can result in failure of the operations, loss of some or all vision, and, in very rare situations, even loss of the eye.
Retinal detachment surgery can cause bleeding under the retina, cataract formation, glaucoma, retinal redetachment, proliferative vitreoretinopathy, vitreous hemorrhage, drooping of the upper lid, and infection. Although any one of these can result in the need for further surgery, or in the total loss of vision, these complications are infrequent. Retinal redetachment is the most commonly occurring problem. If this occurs, your surgeon will discuss the chance that a reoperation will successfully reattach the retina.
Retinal detachment surgery done by scleral buckling can affect the eye muscles that move the eye and keep the eye straight. This can result in double vision, this is usually transient, but on rare occasions is permanent.
Retinal detachment surgery by vitrectomy often leads to the formation of a cataract, if this occurs, this can be treated with a cataract operation.
Please discuss any concerns you may have with your surgeon before the operation.
If you would like to read more about this procedure, further information is available on the website of The ASRS (American Society of Retinal Specialists) https://www.asrs.org/patients/retinal-diseases/6/retinal-detachment