Various surgical techniques can be used to repair a retinal detachment, the choice of which depends on the specific type of retinal detachment each patient presents with.
Laser photocoagulation or cryotherapy
Laser photocoagulation and cryotherapy are used to create a watertight seal around a retinal break or tear, to prevent fluid from passing through and accumulating under the retina.
Scleral buckle surgery
Scleral buckling involves the attachment of a compressive silicone band against the outside ('white part') of the eyeball to treat a retinal detachment via an 'external' approach. Cryotherapy or laser therapy is also performed, in combination with scleral buckling, during the same surgery, to create a watertight seal around the causative retinal break. Sometimes air or gas may be injected into the eye to provide further support for the retina. Following the surgery, the surgeon may recommend you to remain in a particular position for a few days to optimize your recovery.
Vitrectomy is the process of removing the vitreous gel, a clear, jelly-like substance that fills the cavity of the eye. This is the most common technique used to treat a retinal detachment.
During a vitrectomy, the surgeon gains access to the 'inside' of the eyeball via three tiny cuts through the sclera (white part of the eye).
Through these cuts the surgeons will be able to insert various instruments to remove the vitreous gel, drain the fluid under the retina, identify all causative retinal breaks, apply laser therapy to prevent further leakage of fluid, and to inject a gas or silicone oil bubble if necessary.
After the surgery it is often necessary for you to posture your head in a certain manner - most commonly face-down, or lying sideways with cheek-to-pillow - for several days to a week or two, in order to optimize your recovery.
Pneumoretinopexy is the injection of gas into the eye to reverse a retinal detachment. Laser photocoagulation or cryotherapy is applied in combination with pneumoretinopexy, either on the same day or several days after the initial injection of the gas bubble, to seal the causative retinal break.
While this is a less invasive and quicker procedure (than scleral buckling or vitrectomy) which can be performed in the clinic rather than the operating theatre, it is suitable only for certain types of retinal detachments, requires strict post-procedural head posturing to ensure good outcomes, and is associated with a slightly lower success rate of approximately 70% compared to other retinal detachment repair techniques (i.e. scleral buckling and vitrectomy).
Before your operation you will be asked to attend a pre-operative assessment clinic where you will be assessed for fitness for surgery.
The doctor or nurse will ask a detailed medical and medication history and you may require blood tests and ECG to ensure you are fit for surgery.
Sometimes a cataract surgeon must be performed in combination with a retinal detachment repair, in order to facilitate the retinal detachment repair. If this is the case, then additional pre-operative tests (biometry) will be performed to calculate the power of the lens implant appropriate for your eye.
During this visit we will counsel you once again regarding the details of the surgery and answer any questions you if may have any.
The frequency of some of your usual medications, such as blood thinners and diabetes medications, may have to be adjusted slightly just prior to and after the surgery. If this was the case, we will be provide you with a detailed plan of action during this visit.
You will be advised on when you should stop eating and drinking before the operation. On the day of the surgery you will be asked to report to the operating theatre several hours prior to your surgery, usually between 6am to 12pm. You will most likely be advised to stay for one night in hospital following the surgery. As such, it is best for you to bring an overnight bag with toiletries and a change of clothes.
After surgery your eye will be padded with a plastic shield taped over it. The ward nurse will remove the pad and shield the next day, clean the operated eye and instill eye drops for you. She will also show you and your family members the correct way to instill the eye drops and advise you on proper hygiene measures.
You may experience some effects from the local anaesthetic which include numbness over the injected side of the face, light headache and double vision.
These will wear off over the next 1 − 2 days. It is also normal to have some redness, swelling, drooping of the eyelid, and irritation (foreign body sensation) in the operated eye lasting up to 4 weeks. Mild pain may be relieved with analgesics but severe pain, especially if accompanied by headache and vomiting, will require immediate attention.
You will find your vision to be blurred immediately after the surgery, often times even worse than what you started out with, especially if you have gas or oil in the eye. Your vision will most likely improve gradually as the gas is absorbed. If oil was injected into your eye, or if a cataract develops soon after a retinal detachment surgery, then you will require a subsequent surgery, most commonly performed several months after the first surgery, before you might perceive any improvements in your vision.