Your eye specialist has advised you to have retinal detachment surgery. This information will help you decide what to do?Before you have the operation, we will ask you to sign a consent form, so it is important that you understand the information given here before you agree to go ahead with surgery. If you have any questions, you might want to write them down so you will remember to ask one your doctor or one of the hospital staff.
Your eye doctor has diagnosed a retinal detachment in your eye. Without treatment, this condition usually leads to blindness in the affected eye. The retina is a thin layer of nerve cells that lines the inside of the eye. It is sensitive to light (like the film in a camera) and you need it to be able to see properly. Your retina is detached because it has one or more holes in it and so is allowing fluid to pass underneath it. This fluid causes the retina to become separated from the supporting and nourishing tissues underneath it. Small blood vessels might also be bleeding into the vitreous (the jelly substance in the centre of the eye), which might cause further clouding of your vision.
Most retinal detachments occur as a natural ageing process in the eye. It is unlikely that it would be caused by anything that you have done. Anyone can develop a retinal detachment at any time, but certain people are at higher risk than others. These include people who are short sighted, those who have had cataract surgery in the past, and those who have recently suffered a severe direct blow to the eye. Some types of retinal detachments can run in families, but these are rare.
The treatment involves surgery. During the operation, your eye doctor will seal the retinal holes and reattach your retina. An experienced eye surgeon will carry out the operation.
If you decide to have a local anaesthetic, you will be awake during the operation. You will not be able to see what is happening, but you might be aware of bright light. Before the operation, we will give you eye drops to enlarge your pupil. (The pupil is the black circle at the front of your eye). After this, we will give you an anaesthetic to numb your eye. This involves injecting local anaesthetic solution into the area around your eye.
During the operation, we will ask you to lie as flat as possible and keep your head still. The operation normally takes an hour, but might sometimes takes a little longer.
If you decide to have a general anaesthetic, we will ask you not to eat for six hours before we take you to the operating theatre, although you may drink sops of water up to two hours before the operation. Prior to surgery, an anaesthetist will speak to you and examine you on the ward. The nursing staff will give you eye drops to enlarge your pupil. When you arrive in the operating theatre’s anaesthetic room, the anaesthetist will monitor your heart rate, breathing, blood oxygen and blood pressure while you are under the anaesthetic. You may feel tired and sleepy for about six to 12 hours following your surgery.
A) Cryotherapy and sclera buckle
We can seal retinal holes by applying ‘splints’ (buckle) on the wall of the eye. The buckle is made of sponge or solid silicone material. It is positioned under the skin of the eye and usually stays there permanently.
B) Vitrectomy, cryotherapy and injection of gas or silicone oil
In some cases, the jelly-like substance called the ‘vitreous’ is not working and this is responsible for retina becoming detached. As part of your surgery, we remove this jelly during an operation called ‘vitrectomy’. During this operation, we make tiny cuts in the eyes and remove the vitreous. Next laser or cryotherapy. This causes a scar reaction, which over ten days will seal the break. We then put a gas or silicone bubble in the eye. This acts as a ‘splint’ to hold the retina in position until the scar reaction occurs (ten days). If we used a gas bubble, your normal body fluids will replace it naturally over time. If we use silicone oil, we might need to remove this another small operation several months after your first operation.
We usually put small stitches in the eye. At the end of the operation, we will put a pad shield over your eye to protect it. The pad and shield are removed the following morning and you only have to wear the clear eye shield at night-time for three weeks after your operation.
If you have discomfort, we suggest that you take a pain reliever, such as paracetamol, every four to six hours – but not aspirin as this can cause bleeding. It is normal to feel itching, sticky eyelids and mild discomfort (gritty sensation due to the stitches) in the operated eye for five to ten days following retinal detachment surgery. It is common for some fluid to leak from around your eye. Occasionally, the area surrounding the eyes can become slightly bruised. Any discomfort should ease after one to two days. In most cases, your eye will take about two to six weeks to heal. You will see your doctor in the clinic usually within seven to 14 days of your operation. Try to rest while your eye is healing.
We will give you eye drops to reduce any inflammation and to prevent infection. We will explain how and when you should use them. Please don’t rub your eye.
Certain symptoms could mean that you need prompt treatment. Please contact the hospital immediately if you have any of the following symptoms.
- A lot of pain.
- Loss of vision.
- Increasing redness of the eye.
This is the hardest part of the recovery following your surgery, but the most important. If we put a gas or silicon oil in your eye, we will usually ask you to keep your head any body in a particular position. This is called ‘posturing’ and aims to provide support to seal the holes in your retina. Your surgeon will decide whether it is necessary for you to posture after your surgery.
The bubble floats inside the eye cavity and we will usually ask you to hold your head in a position so that the bubble lies against the holes. This is an important part of the treatment, and the position you hold your head in will depend on where the holes are in your retina. We might also advice you to sleep in a particular position at night. By following our instructions, you will give your retina the best chance to be successfully treated. Your co-operation matters a great deal.
As the gas bubble begins to disperse, you will notice a line in your vision that moves, similar to a spirit level. You will be able to see above the line, but under the line the vision will be fuzzy or blurred. The gas will eventually disperse until it is only a small bubble in the bottom of your eye and then the bubble will disappear too. The length of time the gas stays in your eye depends on which gas is used.
There are two types of gas, a short acting gas, SF6. Which will stay in the eye for two-three weeks, and a long acting gas, C3F8, which can stay in the eye for up to two months.
- You must not fly while there is gas in your eye.
- You must inform the anaesthetist if you have a general anaesthetic for any operation while there is still gas in your eye, as he / she cannot use nitrous oxide gas in your anaesthetic.
The most obvious benefits are preventing you from going blind. You have already lost some sight because of the detached retina. If the surgery is successful, it will usually bring back some, but not all of your sight.
Retinal detachment surgery is not always successful. Every patient is different and some detached retinas are more complicated to treat than others. Some patients might need more than one operation. Your surgeon will discuss with you the risks and benefits of the operation you are about to have.
These are the risks and benefits that appear on the consent form for the operation:
1. There is an 85-90% success with one operation of your retina going flat and staying flat. There is a 5-10% risk that you will need further surgery due to new breaks forming in the retina or the development of scar tissue.
2. Due to the surgery and the insertion of gas in your eye, you could develop a cataract in the operated eye, this is easily treated when the cataract matures.
3. Every surgical procedure carries the risk of infection and haemorrhage (bleeding). Eye surgery is no different – the risks are low, but should they occur, you could have permanent visual loss.
Complications are not common and in most cases we can treat effectively. Very rarely some complications can result in blindness.
- Bruising of the eye or eyelids.
- High pressure inside the eye.
- Inflammation inside the eye.
- Double vision.
- Allergy to the medication used.
- Infection in the eye (endophthalmitis). This is very rare, but can lead to serious loss of sight.
If you fall into the 5-10% who develop another retinal hole or develop scar tissue, you will need to have more operations. When a retina is detached, the eye naturally tries to heal the damage. Instead of being helpful, this healing process leads to scar tissue forming inside the eye and the retina contracting. Your doctor might refer to this as ‘proliferative vitretinopanthy’ or PVR for short. PVR is associated with poorer vision and may cause the retina to become detached again after successful surgery to reattach it.
Like a camera, the eye has a lens, which focuses light onto the retina. When the lens of the eye becomes cloudy, this is called a cataract. You are more likely to develop a cataract, party because of the detached retain and partly because of the surgery you received. We can treat cataracts by removing the lens and replacing it with a plastic lens.
After surgery, it usually takes some weeks for your vision to recover. If we used a gas bubble, your vision will be very blurry immediately after surgery. This is normal and you should not be alarmed by it. Once the retina is attached, your sight will continue to improve slowly over several months. You might be given sight tests to see if glasses would improve your vision.
Your final vision will depend on the nature of your original detached retina. If we diagnose and treat it quickly and successfully, most of your vision will be restored. If, when we diagnose a detached retina, the eye already has poor vision, we might not be able to restore some of your sight. You might not be able to read using the affected eye. Form a distance, you might not recognise faces or be able to read car numbers plates, for example. This allows you to see vision is very important for day-to-day activities such as going out and climbing stairs.
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