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
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
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).
