Retinal detachment surgery
Retinal detachment is a surgical emergency. If you have a retinal detachment, surgery will be offered within 72 hours. There are two surgical techniques: vitrectomy and cryoindentation. Their effectiveness is comparable, and the indications depend on parameters that will be evaluated by your ophthalmologist. The operations are most often performed under local (peribulbar) anesthesia. The technique involves cauterizing the tear responsible for the detachment and draining the subretinal fluid. Recovery takes 3 to 4 weeks on average.
Surgical techniques
Vitrectomy – Endocular Surgery
Vitrectomy is a technique that involves inserting instruments into the eye and working directly within the ocular cavity.
This recent method is the most widely used. Its main drawback is the risk of cataracts.
In the event of gas tamponade, vision will remain blurred for several weeks and high-altitude travel (pressure variations) will be contraindicated until it has completely disappeared.
Cryoindentation – External surgery “ab externo”
This method is preferentially suited to young patients because it avoids the onset of cataracts (and therefore preserves accommodation).
Indeed, during this procedure, the surgeon attaches a silicone strip to the wall of the eye (sclera) without entering the eye.
Visual recovery is typically faster than with vitrectomy. A revision vitrectomy is possible if the initial procedure fails.
The day of the operation
You will be required to arrive on an empty stomach, having eaten since 6 a.m., at the time indicated on your summons. Please note: do not consume coffee, tea, food, liquids, or cigarettes.
The procedure typically lasts about one hour, but this can vary considerably. Afterwards, if the surgery was performed on an outpatient basis (the most common case), you will be able to return home accompanied by someone who has accompanied you.
Before the operation: the anesthesia consultation
Before the surgery, you will see the anesthesiologist: either in your room or upon arrival in the operating room, as this is an emergency. For this surgery, regional anesthesia is most often used.
For this consultation, remember to gather your medical records and documents available: list of treatments, medical history, medical examinations, medical reports which will help the anesthesiologist to draw up a complete medical assessment.
A closer look at vitrectomy
Retinal detachment surgery is usually performed under regional anesthesia, also known as peribulbar anesthesia. An anesthetic is injected around the eyeball to desensitize it.
The major stages of surgery
Vitrectomy – The surgeon cuts and aspirates the vitreous, which is replaced by water, thus releasing vitreoretinal traction.
Pexy – By laser (heat) or cryotherapy (cold), the retina is pexed (reattached) to the pigment epithelium from which it had become detached.
Tamponification – With gas or silicone depending on the nature and extent of the retinal detachment.
Sutures – Always absorbable, they are not systematic.
The buffering
Following the surgery, a tamponade will be left in your eye. This helps to hold the retina in position after the surgery by pressing it against the wall of the eye.
This will most often involve a gas, which is absorbed spontaneously within 2 to 6 weeks depending on the type of gas used. Vision will be obstructed for the entire duration of its use, and pressure changes should be avoided (contraindicated for air travel and stays at high altitudes).
The alternative is silicone, the drawback of which is that it must be removed during a second surgery. It is used in cases of detachments with the least favorable prognosis and in cases of recurrence.
Positioning
Following surgery, you will be asked to maintain a specific head position for 3 to 5 days. The gas, like in a spirit level, rises, and the goal is to achieve maximum support over the tear.
During the hours following surgery, you will be asked to keep your head flat towards the ground for about 6 hours.
Then, for 3 to 5 days, maintain the head position which will depend on the location of the tear.
This step is essential for the success of the surgery and for healing. If it is not observed, the risk of recurrence is significantly increased.
A closer look at cryo-denting
Cryoindentation is a surgical technique that allows for penetration of the eye without entering the eye.
It is used in young patients (< 50 years old) because it does not cause cataracts.
The procedure involves cauterizing the tear using a cold probe (cryode) before placing a silicone strip under the eye muscles to support (indent) the sclera.
Duration of the operation
For a vitrectomy, it takes 20 to 30 minutes for a simple retinal detachment operation, but 40 minutes to 1 hour for a complex retinal detachment.
For cryo-indentation, the operating time is 45 minutes to 1 hour 30 minutes depending on the size of the detachment.
Convalescence and post-operative care
Regardless of the method used, rest is recommended for approximately one month, as this is a period of significant risk for recurrence. In the case of external surgery, the absence of tamponade results in a shorter recovery period.
In the case of a vitrectomy, a gas tamponade will often be left in place in the orbital cavity to maintain the retina's proper alignment. This will obstruct vision for an average of 2 to 6 weeks.
Because the gas may expand with pressure changes, travel to high altitudes (mountains, airplanes, etc.) is ABSOLUTELY contraindicated. If you must travel following surgery, speak to your surgeon.
Here's what you should expect after the operation:
You may experience some discomfort for a few days to a few weeks after the operation. You will be given pain medication to help you feel better.
You will need to rest and be less active for a few weeks after the operation. Your ophthalmologist will tell you when you can resume exercising, driving, or other activities.
You will need to wear an eye patch after the operation. Be sure to wear it for as long as your doctor tells you to.
If a bubble has been placed in your eye, you will need to keep your head in the same position for a certain period of time, for example, 1 to 2 weeks. Your doctor will tell you what this specific head position is. It is very important to follow the instructions for your eye to heal.
You may experience floaters and flashes of light for a few weeks after the operation. You may also notice a bubble in your eye.
Your vision should begin to improve about four to six weeks after surgery. It may take months for your vision to stop changing. In addition, your retina may still be healing for a year or more after the operation.
The improvement in your vision depends on the damage the detachment caused to the retinal cells. Therefore, your recovery is independent of any issues related to glasses.
What are the risks of the operation?
All surgery carries risks of complications. But if you don't treat a retinal detachment, you will quickly and permanently lose your sight. Here are the main surgical risks:
Recurrence – 5 to 10%, this is the most frequent complication, caused by a new tear or poor healing (proliferative vitreoretinopathy – PVR). Recurrence requires a second surgical intervention.
Cataract – The lens of your eye becomes cloudy. This is a benign condition.
Endophthalmitis – A serious infection of the eye.
Vitreous hemorrhage – bleeding in the eye
Ocular hypertension – Increased pressure inside the eye, which can lead to glaucoma.
Macular edema – The operation can cause inflammation of the retina called Irvin Gass, resulting in edema of the macula.
Pucker – A thin membrane may form on the macula after the operation. If the macula becomes wrinkled, a second operation will be necessary to remove the membrane.
Prognosis of retinal detachment
The prognosis for retinal detachment is marked by two elements:
The initial stage of severity. Macular detachments (whether the macula is on or off for less than 48 hours) generally have good recoveries. If the macula has been detached for more than 48 hours, sequelae are frequent and highly variable depending on numerous factors.
The risk of recurrence is approximately 10 to 20%, depending on the type of detachment. Proliferative vitreoretinopathy (PVR), an abnormal scarring process similar to keloids on the skin, is the main cause.
What is the visual recovery like after a retinal detachment?
Retinal detachment is an extremely serious retinal condition! Without surgery, vision becomes completely lost. After surgery, visual recovery generally takes several months. Visual recovery can be summarized as follows:
In cases of retinal detachment WITHOUT macular detachment, visual recovery will be complete.
In cases of retinal detachment with a raised macula:
⅓ of patients recover 10/10 vision.
⅓ of patients recover 6 to 9 out of 10.
One-third of patients will have visual acuity not exceeding 5/10.
Frequently Asked Questions
How long does retinal detachment surgery take?
The duration of retinal detachment surgery varies depending on its complexity and the technique used.
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A vitrectomy lasts on average 20 to 60 minutes.
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A cryo-indentation procedure lasts from 30 to 90 minutes.
What is the recovery process like after retinal detachment surgery?
After retinal detachment surgery, recovery lasts 3 to 6 weeks. The gas will dissipate from top to bottom, gradually restoring vision.
Is there a laser surgery for retinal detachment?
No! Only retinal tears can be treated with lasers. Retinal detachments, on the other hand, require surgery.