Retinal Detachment Repair by Vitrectomy, Scleral Buckling, or Pneumatic Retinopexy

Pneumatic retinopexy

Pneumatic retinopexy is an effective surgery for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is performed in the office with local anesthesia. During pneumatic retinopexy, Dr. Fern injects a gas bubble into the middle of the eye. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. Dr. Fern then uses a laser (photocoagulation) to seal the tear in the retina. The bubble remains for about one to three weeks to help flatten the retina, until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble. What to Expect After Surgery

Recovery from pneumatic retinopexy takes about 3 weeks. The local anesthetic affects only the eye and wears off quickly. The hardest part of the recovery is keeping the gas bubble in the right place until a seal forms around the tear in the retina. You must keep your head and eye in the proper position for 16 to 21 hours a day for 1 to 3 weeks after the surgery. You cannot lie on your back or the bubble will move to the front of the eye and press against the lens. Airplane travel is dangerous, because the change in altitude may cause the gas bubble to expand and increase the pressure inside the eye.

Why It Is Done

The location and size of a tear in the retina determines whether pneumatic retinopexy can be used. Pneumatic retinopexy can be useful when:

• A single break or tear caused the detachment.
  
• Multiple breaks are small and close to each other.
  
• The break is in the upper part of the retina.
  
• The break must be in the upper half of the eyeball for pneumatic retinopexy to be practical. You have to be able to position your head so that the break and the bubble are at the highest point. If the break was on the bottom of the eyeball, you would have to stay upside down during your recovery, which would not be practical.

How Well It Works

A single treatment with pneumatic retinopexy reattaches the retina most of the time. With additional treatments such as vitrectomy or scleral buckling, the surgery is successful nearly all the time.

Chances for good vision after surgery are higher if the macula was still attached before surgery. If the detachment affected the macula, good vision after surgery is still possible but less likely.

Scleral Buckle

Scleral buckling is a surgical procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of a retinal tear to push the sclera toward the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. It also prevents fluid leakage which could cause further retinal detachment. Once the buckle is positioned Dr. Fern will suture the buckle into place and then cover it with the conjunctiva. The procedure is most often performed under local anesthesia and is generally an outpatient surgery.

Vitrectomy

Vitrectomy is a microsurgical surgery in which specialized instruments are used to remove the vitreous and to repair a retinal detachment. During a vitrectomy, Dr. Fern makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, laser is used to "weld" the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months up to a year following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

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