Retinal Detachment & Vitrectomy

What is a retinal detachment?

The retina is the light sensitive film at the back of the eye and retinal detachment is a condition where the retina peels away from the inner wall of the eye. In most cases the retina detaches because a hole or a tear has formed in the retina allowing fluid to pass underneath the retina.

Most retinal detachments occur as a natural ageing process in the eye but certain people are at higher risk than others. These include people who are short sighted, those who have had cataract surgery in the past and those who have suffered a severe direct blow to the eye. Some types of retinal detachments can run in families but are rare.

What is the treatment for retinal detachment?

The treatment involves surgery and the main aim of surgery is to seal holes in the retina and reattach the retina. The two methods used in retinal detachment surgery are vitrectomy or scleral buckle or a combination of the two.

Vitrectomy

A vitrectomy involves removing the vitreous gel (that has caused the retinal tear) from inside the eye. Then to seal the tear the surgeon uses either laser or a freezing probe to make a scar around the tear. A gas or silicone oil bubble is then inserted into the eye to support the retina while it heals. 

A gas bubble slowly absorbs over 2 to 8 weeks but a silicone oil bubble will need a small operation to remove it at a later date. Your vision will be very blurred initially due to the presence of the gas or oil bubble.

To use the gas or oil bubble to its best effect your surgeon may ask you to posture and this will be covered in a following section.

Scleral buckle

The retinal holes can also be sealed and supported by stitching a piece of silicone rubber or sponge to the outside of the eye. 

This acts as a ‘splint’ and produces a dent within the eye and pushes the outer wall of the eye up to the hole in the retina. The buckle is not visible on the outside of the eye and usually remains in place permanently.

What is posturing?

With a gas or oil bubble in the eye your surgeon may ask you to posture after the operation for up to 10 days. Posturing involves placing your head in a specific position to allow the gas or oil bubble to float into the best position to support the retina. There are various posturing positions and your surgeon will advise you on the one appropriate to you.

Posturing is often the hardest part of the recovery after surgery but is important and should be regarded as the second stage of the operation. You will be required to posture 45 minutes out of every hour during the day. The 15 minutes out of every hour when you are not posturing should be spent moving around or taking gentle exercise to relieve discomfort and general body ache.

What are the benefits of retinal detachment surgery?

The most obvious benefit is to prevent you from going blind in the affected eye. You may have lost vision already from the retinal detachment and even with successful surgery your vision may not return to normal.

What anaesthetic is required for retinal detachment surgery?

Retinal detachment surgery is usually performed under local anaesthetic, you will be awake but you will not feel any discomfort as the eye will be numbed with an injection.

You will not see the operation and the other eye will be covered. 

What are the risks of retinal detachment surgery?

Retinal detachment surgery is not always successful. Every patient is different and some retinal detachments are harder to treat than others. Some patients may need more than one operation.

The most common and significant risks of surgery are:

1. The success rate for retinal detachment surgery is approximately 90% with a single operation. This means that 1 in 10 people (10%) will need more than one operation. The reasons for this are new tears forming in the retina or the eye forming scar tissue which contracts and pulls off the retina again.

2. If a gas or oil bubble is used during surgery then you will usually develop a cataract in the eye within the first 18 months. A cataract is the lens of the eye becoming cloudy and will require a short operation to remove it.

3. Any surgical procedure carries a risk of haemorrhage and infection but in retinal detachment surgery this risk is very low (less than one in a thousand). Although it is rare, retinal surgery can have serious consequences as it can cause blindness.

What should I expect after the operation?

Although retinal detachment surgery is a major operation, it is rarely very painful. It is normal to experience some discomfort in the eye after surgery but this is usually relieved with simple painkillers such as paracetamol or ibuprofen.

The white of the eye will look red and the eyelid may appear swollen following surgery. You may also experience some watering from the operated eye and a gritty sensation during the first month following surgery as any stitches gradually dissolve. The redness, eyelid swelling and watering will gradually improve. 

Vision in the operated eye will usually be very blurred for the first few weeks but will slowly improve. The final visual result may take several weeks or months and you may require new glasses. Your surgeon will discuss with you the expected final outcome of your vision.

Will I need to instil eye drops after the operation?

You will be given an eye drop to reduce inflammation (steroid drop), another to prevent infection (antibiotic), and pupil dilating drops to keep the eye comfortable. You will be advised on how many times a day to use the drops before you leave hospital. Use the drops regularly until your first postoperative outpatient visit. You will then be given further instructions on how long the drops need to continue for.

What can I do after surgery?

If you have been given any posturing instructions then these should be strictly followed. You can bath or shower, but avoid splashing water near the eye or pressing directly on the eye. Generally you may do anything with which you are comfortable provided it is not too strenuous, during the posturing breaks each hour.

You must not fly until the gas bubble has gone and you must inform the anaesthetist if you require a general anaesthetic for any operation while there is gas in your eye.

Further surgery

Retinal detachment surgery is not always successful. Every patient is different detached and some retinas are more complicated to treat than others. Some patients may need more than one operation. Your surgeon will talk to you about the chances of success with the operation you are about to have.

Expectations after surgery

After surgery, it usually takes some weeks for your vision to recover. If we use a bubble, your vision will be very blurred immediately after surgery. This is normal and you should not be alarmed by it. Once the retina is attached, your sight will continue to improve slowly over several months. You may be given sight tests to see if glasses would help you see.

Your final vision will depend on the nature of your original detached retina. If we diagnose and treat it quickly and successfully, most of your vision will be restored. If when we diagnose a detached retina, the eye already has poor vision, we may not be able to restore some of your sight.

You may not recognise faces or be able to read number plates, for example. Your peripheral vision will usually be preserved. This allows you to see people and objects approaching you from the sides. This peripheral vision is very important for day-to-day activities such as going out and climbing stairs.

How much time off work will I need?

Most people will need at least two weeks off work after surgery. Sometimes this may be longer. While there is gas in the eye the vision is quite poor and the ability to judge distance is affected. The amount of time off work will depend on the kind of work you do and the kind of surgery that is done. This will need to be discussed with your surgeon.

Where can I find more information?

The RNIB have further information on macular holes, especially some practical advice: Helpline 0303 123 9999, internet : www.rnib.org.uk,
email : helpline@rnib.org.uk The Macular Disease Society: Helpline 0845 241 2041, internet: www.maculardisease.org, email: info@maculardisease.org

The advice on this page is based on a variety of sources, including latest research published in peer-reviewed scientific journals. It has also been scrutinized by a panel of experts from the Britain & Eire Association of Vitreoretinal Surgeons (“BEAVRS”). If you require further information about this, please ask your surgeon.

What are the Costs of Surgery?

Initial no obligation consultation with diagnostics – £200

Vitrectomy surgery for a retinal detachment – £5,500 per eye
2 Free post-operative check-up appointments included

Interest free finance over 12 months available – subject to status 

PLEASE NOTE

Information on consultant’s individual fee structures can be found on their bio pages, which can be found in the drop-down menu at the top of the website, or by clicking here.

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