Retinal Detachment

The retina is a thin layer of nerve cells and blood vessels that lines the inside of the eye. It is sensitive to light like the film in a camera and is essential for you to be able to see.

Retinal Detachments occur when a hole or several holes have developed in the retina, fluid has passed through the holes causing the retina to peel away from the inside of the eye similar to a blister. The result of this process is the loss of whole or part of your vision. Without treatment this usually leads to permanent loss of vision in the affected eye.

A retinal detachment can occur at any time with no apparent cause. It is known that some people are at a greater risk of developing retinal detachments; for instance people who are short sighted, those who have had cataract surgery and those who have had a severe blow directly to the eye. Further information is also available in the booklet ‘Retinal Detachment’ published by the Royal National Institute for the Blind RNIB.

Do I need treatment?

Yes, as the most obvious benefit is the prevention of blindness and restoration of vision. You will have already lost some of your sight as a result of the retinal detachment. Successful surgery will usually bring back some of your sight, however it will not usually completely restore your vision.

You need to be aware that surgery for retinal detachment is not always successful. Every patient is different and retinal detachments vary in their complexity. It is important that you realise that some patients need more than one operation to treat their retinal detachment. Your surgeon will advise you on the chances of success with the operation.

The operation is aimed at sealing the retinal holes and reattaching the retina to the inside of the eye. We normally carry out the operation under local anaesthetic. You will be awake for the whole operation. You will be aware of bright lights and you may experience some slight discomfort. You will have an injection of local anaesthetic into the tissues around the eye, which numbs your eye. You will need to keep your head still for the duration of the operation. In some circumstances you may need a general anaesthetic; in this case you will be asked not to eat or drink for several hours before the operation. The anesthetist will come and visit you on the ward before the operation takes place. You will be asleep for the operation, which takes approximately one hour.

Surgery for Retinal Detachment:

There are two approaches to retinal detachment surgery, these are described below. Your surgeon will advise you which approach is best for your particular case before the operation. You will also be warned that the plan may change during the operation, depending on how the eye and retina behaves during the operation.

Internal approach:

This approach is most commonly used. An operation called Vitrectomy is performed which is undertaken by making three tiny incisions approximately 1 mm long in the white of the eye so that tiny instruments can be used to cut away the vitreous gel from inside the eye. As this is happening, the vitreous is replaced by a salty fluid. After removal of the vitreous, the retina is repositioned using an internal splint. This is either a gas bubble or silicone oil, which supports the retina whilst healing takes place. This choice is made depending upon how the eye and retina behave during the procedure. It is a combination of a freezing treatment to the white of the eye and / or laser treatment to the retina, to help seal the retinal holes. Small stitches are used to seal incisions made in the white of the eye.

During the operation you may be aware of pressure sensations around the eye, or some shadows and lights inside the eye. This is quite normal as the retina is still functioning. The amount varies due to the intensity of the local anaesthetic. Following surgery you will need to use eye drops for up to 6 weeks whilst the eye heals. You will be advised on how and when to use the eye drops before leaving hospital. The drops are to prevent infection and to reduce inflammation around the eye.

When a gas bubble has been used to help the hole to heal, it is very important that you must not travel by aeroplane until the gas has been absorbed (this can be up to 8 weeks). Your doctor will be able to confirm this with you when you are seen in outpatients. If you need a general anaesthetic for another problem, it is essential that you inform the anesthetist that you have a gas inside the eye. In most cases, you may be asked to keep your head in a specific position to help the gas bubble do its job; this will be discussed with you before the operation and written instructions will be given to you before you go home. Sometimes a special type of oil (silicone oil) is used instead of gas. This is usually removed later at a second operation. Your doctor will give you full details, should this be necessary.

External approach:

Retinal holes can be sealed and supported by applying a silicone splint to the outside wall of the eye. This is stitched in place to the white part of the eye and placed under the eye muscles in the area of the retinal holes. The thin conjunctival membrane that covers the eye also covers the splint. The splint stays on the eye permanently and is not visible to the naked eye. It is a combination of a freezing treatment to the white of the eye and laser treatment to the retina to help seal the retinal holes.