What is a retinal detachment?
Retinal detachment is caused by a hole or tear in the retina (this is the film of the eye that processes images and gives us vision) which then causes fluid to accumulate beneath the retina. This in turn causes the retina to become detached from the wall of the eye.
What are the symptoms?
Patients with this condition may have noticed flashing lights and floaters followed by a permanent shadow across the vision which progressively enlarges. Sometimes this is like a curtain coming down.
What happens if nothing is done?
This is a blinding condition and requires surgery to prevent further loss of vision. Surgery does not guarantee restoration of vision.
What is involved in surgery?
Surgery involves flattening the retina with an operation on the outside of the eye (cryo/buckle) or on the inside of the eye (vitrectomy)
A vitrectomy is keyhole surgery of the eye whereby vitreous is removed using a special cutter. The retina is reattached using laser and a gas bubble. The gas bubble is used to float against the retinal hole / tear and therefore the head must be ‘positioned’ to get the bubble in the correct place. This is known as ‘Positioning or Posturing’
A cryo/buckle involves stitching a small band of plastic to the eye wall to produce an ‘indent’ this allows the retina to reattach to the wall of the eye. Fluid is drained from beneath the retina via the wall of the eye. Sometimes it is necessary to put a gas bubble in the eye. Usually ‘positioning’ is not necessary but occasionally you may be asked to lie in a specific position after surgery.
Most retinal surgery is performed under general anaesthetic but can be performed if necessary under local anaesthesia. All surgery requires an overnight stay.
What happens after surgery?
Once at home if you are r quested to posture this is performed for 2 weeks, 45 – 50mins per hour day and night.
You will be asked to put in eye drops and instructions will be given.
Vision is very blurred for at least 2 weeks. Vision improvement depends on the extent of the detachment and duration of the detachment.
Following surgery review takes place at 2 and 6 weeks then 3 and 6 months depending on progress
What is the success rate and what are the risks?
Success for reattachment with one operation is within the region of 80%, that means there is a 1 in 5 risk of needing further surgery. Other risks involved are:
infection < 1%
Bleeding < 1%
Blindness form the above < 0.1%
Cataract – very common after vitrectomy
Double vision , 1%
Sympathetic ophthalmia is a rare complication of inflammation in the unoperated eye. This is a less then 0.01% risk. The risk however increases with each operation by about 10%. This condition can be treated quite successfully with steroids or immunesuppressants.
Remember, without surgery the eye will lose all it’s vision.