Featuring Dr. Michael Kapusta, MD, FRSCS, Ophthalmologist

Duration: 5 minutes, 19 seconds

Retinal detachments can be repaired in three general ways. The first is pneumatic retinopexy, where the surgeon will place a bubble of gas into the eye and treat the retinal tear with either cryotherapy, or at a later stage with a laser procedure.

The second procedure is called scleral buckle. This is done in the operating room, where the surgeon will put a silicone belt around the wall of the eye. This indents the eye and relieves the traction on the retinal tear and allows the retina to reattach.

The third and most common way of repairing a retinal detachment involves a procedure called vitrectomy, where the surgeon in the operating room goes inside the eye with an infusion line, light and a cutting device called a vitrector and removes the jelly of the eye, which is called vitreous.

The procedure is done typically under local anesthetic and it is the most common way to repair the retina. One uses gas and laser in the eye in order to force the retina into position and hold it there with a laser. At the conclusion of the surgery the patient typically will require a particular head position in order to allow the retina to stay attached.

Retinal detachments occur across a wide spectrum of age. A patient’s age and their previous ocular history, including history surgery, do have implications in terms of what type of repair your vitreoretinal surgeon might choose to use.

For example, a younger patient might be more likely to have a scleral buckle procedure. Vitrectomy causes cataract, so a patient who is older or a patient who has already had cataract surgery performed would be more likely to have a vitrectomy operation.

In the repair of a retinal detachment, pneumatic retinopexy as one technique is typically done in the patient’s own chair while they’re sitting in the office. The tools to repair that retina are present in the office setting. That’s a convenience that is very helpful in terms of rapid repair of a retinal detachment.

A pneumatic retinopexy may take only 15 or 20 minutes. The recovery actually takes a lot longer. Patients are required to keep their head in a particular position in order to allow the gas bubble to hold the retinal tear closed.

It may take as much as one or two weeks of strict head positioning to recover from the pneumatic retinopexy procedure. In order to determine whether the patient is recovering from pneumatic retinopexy, there will be follow-up visits – typically at one day or one week after the procedure.

In the weeks that follow, the gas bubble dissipates, and it’s at that point in time that we can determine whether the retina still stays on without the help of that gas bubble.

Scleral buckle is an operation that is typically done under local – but it might be under general – anesthesia, but definitely in the operating room. Recovery from a scleral buckle operation involves no head positioning, and no particular restrictions with respect to travel, because there’s no gas bubble placed at the time of surgery.

This surgery is somewhat more painful in its procedure and in the recovery than the other two possible retinal detachment repair methods. A pars plana vitrectomy is an operation that is performed under local or general anesthesia – typically local – again, this is performed in the operating a room.

The recovery from pars plana vitrectomy does imply the need for a patient to maintain a particular head position. A patient’s surgeon will tell them what that position should be after the procedure, and this does, in some cases, imply the need for one side of their head down, versus strict facedown positioning, sometimes this depends on where the location of the retinal breaks or tears were as they were located at the time of surgery.

Depending on the location of the retinal tears, there are different gases used during the vitrectomy conclusion. Some of them last longer than others, and this will have implications for how long a patient needs to keep their head down, and how long they are restricted from air travel.

With any of the techniques that we’ve discussed: pneumatic retinopexy, scleral buckle or pars plana vitrectomy, the success rate could be as high as 80 or 90 percent. There is the potential for retinal detachment to recur. Recurrent retinal detachment may have symptoms and require that the patient seeks out attention from their retinal surgeon. There may be more procedures that are required.

If you are concerned that you have a retinal detachment, you should seek out attention from an optometrist, or an ophthalmologist, who may then refer you to a vitreoretinal surgeon. If you have already had retinal detachment repair, and you’re concerned that there’s recurrent retinal detachment, you should directly seek out a surgery consultation from your primary vitreoretinal surgeon.

Presenter: Dr. Michael Kapusta, Ophthalmologist, Montreal, QC

Local Practitioners: Ophthalmologist