Retinal Detachment

There are 3 types of retinal detachment. Rhegmatogenous (following a tear of the retina) is the most common type of retinal detachment. The detachment usually manifests itself as a black shadow that gradually grows while vision decreases. In this case emergency surgery is the only possible way to prevent permanent loss of vision. Prior to shadow symptoms, quite often flashing lights and increased floaters are present.

Ideally, surgery must be performed within 24 hours; however, there are types of detachments that allow the surgery to be scheduled later.

In most cases the procedure is called a vitrectomy. It usually lasts less than an hour and is performed under local anesthesia and the overall time the patient stays in the clinic is 4-5 hours.

The operated eye remains closed for 12 to 24h until the next day review. Drops are prescribed for 2 to 4 weeks. Depending on the type of operation, most of the time vision does not return for at least 2 to 8 weeks. This is due to the use of intraocular tamponades, usually gas bubbles which create significant reflections of light thus not allowing for vital vision to be perceived. Gas bubbles are reabsorbed and replaced by clear fluid which gradually allows vision to be restored. Sometimes, silicone oil tamponade may have to be used, which allows vision to be present after surgery. These are used in more complex cases where tamponade is needed for longer periods and require further surgery to be removed.

In a few cases where there are complications following the detachment of the cornea, a silicone oil bubble is inserted in the eye to improve vision, but this can only be surgically removed. The time and the degree of eyesight recovery depends on the characteristics of the detachment. If the detachment has not reached the macula, then the patient’s full vision should be restored.

The duration of absence from work ranges between 2-4 weeks depending on the type of work and it is recommended that the patient avoids driving until the gas is absorbed. Furthermore, while there is gas in the eye, activities such as air travel, high altitude mountain climbing and diving are not allowed as they affect the composition of the gas, which could lead to loss of vision. This restriction does not apply when silicone oil is used.

The surgical success rate for this type of operation ranges between 70-90% depending on the type of detachment. If surgery fails, it can be repeated, but the more operations we perform, the worst the prognosis for vision. About 1 in 40 eyes with detachment will not be successfully treated regardless of the number of operations and the patient’s vision will be very poor.

Vitrectomy accelerates the development of cataract in the eye (if no cataract surgery has been performed) and most patients will need to undergo cataract surgery within a period ranging from a few weeks to five years.

In some cases, especially in young adults and children, instead of vitrectomy, the “traditional” method of scleral bucking is used, i.e. the placement of a scleral explant, usually while the patient is under general anesthesia. In this case the operation is performed mostly on the outer wall rather than the eye cavity. The success rate is similar to that of vitrectomy, while the danger of cataract development is practically non-existent.

A third option for the treatment of detachments is pneumatic retinopexy. The advantage of this method is that it is quick. It must only be used in carefully selected cases to achieve the same success rates as the two previous methods.