Step 1 – Learn the basics of retinal detachment
Step 2 – Learn about the procedure and what to expect
Step 3 – Learn about the other options
Step 4 – Learn about the potential risks of the procedure
Step 5 – Learn to maximize your results
The eye can be thought of as similar to a camera, with two main parts, a lens and a film. In addition, there is a gel called the vitreous that is located in front of the retina and is very firmly adherent to it. The film layer is called the retina and lines the back wall of the eye. The cells responsible for converting light to an electrical signal and producing vision are located in the outer layer of the retina. This layer receives blood flow from the outer wall of the eye. A retinal detachment is a separation of the outer layer of the retina from the wall of the eye.
The gel (vitreous) seperates from the back of the eye towards the front of the eye as a normal part of aging. As the gel separates, it is a tug of war between the retina and the vitreous. The vitreous may pull hard enough that it rips a hole in the retina. A hole in the retina allows the fluid portion of the vitreous to pass through the retinal hole and travel underneath the retina. This fluid separates the retina from its blood supply and causes the patient to see a dark area in the peripheral vision. If the fluid travels underneath the central vision then it causes blurriness of the central vision.
Pneumatic retinopexy is a procedure used to repair select types of retinal detachments. It is an in-office procedure which is typically performed with topical (eye drops) anesthesia. It is not a painful procedure.
The retina specialist gently inserts a needle through the white of the eye, into the vitreous cavity, and injects a gas bubble into the eye. The patient will then be asked to maintain a particular head position so that the gas bubble (which rises) will cover the retinal tear. This prevents additional fluid from within the vitreous cavity from entering the retina tear and allows absorption of the fluid underneath the retina. Cryotherapy (freezing treatment) or laser therapy is then utilized to create a seal around the retinal tear, and prevent fluid from entering the retinal tear after the gas bubble resolves. The gas bubble typically resolves over a period of 2-8 weeks.
The retina specialists will discuss the risks, benefits, and alternatives to the procedure. The technician will then have the patient sign a consent form and begin numbing the eye for the procedure. A combination of numbing eye drops and gel is typically used to minimize any discomfort for the procedure. They may be applied several times.
After an appropriate amount of time has elapsed for adequate anesthesia (typically 5-15 minutes) the retina specialist will begin the procedure. Sterile dressing is typically placed around the eye to decrease the risk of infection. Betadine is typically placed on the eyelashes, eyelids, and on the eyeball to further decrease the risk of infection. An eyelid speculum is gently placed to keep the eye open; This is not painful. The patient is asked to look in a particular direction and a small amount of fluid is removed from the eye. There may be a slight pressure on the eye during this step, but there should be no sharp pain. The patient is once gain asked to look in a particular direction. The white of the eye is then painlessly marked at the site of the injection. The gas bubble is thereafter injected into the eye ball. During this stage, patients may feel mild pressure. It is critical to continue looking in the appropriate direction. The gas bubble may perceive as many small black bubbles at the bottom of the vision or as one large bubble at the bottom of the vision. The eye is then examined briefly. If there is evidence of high eye pressure, an additional small amount of fluid may be removed. The eye is then rinsed out with an eye wash and the speculum removed. Appropriate positioning is then initiated.
In some cases, cryotherapy therapy will then be applied to the retinal tear the same day as injection of the gas bubble. This is typically performed with topical anesthesia. An eyelid speculum may be used to assist the patient in keeping the eye open. The patient is directed to look in a particular direction and a freezing probe is placed overlying the retinal tear. The retina specialist then uses an indirect ophthalmoscope to verify it is in the correct location and apply the freezing therapy. The patient may note pressure and a dull pain during the time of freezing therapy. The freezing therapy lasts approximately 15 seconds. The cryotherapy probe is then removed. Most patients will complain of a dull achy sensation and accompanying headache that may last minutes-hours. Many patients may find that taking acetaminophen prior to the procedure and at the next scheduled time following the procedure helps to decrease pain.
Laser retinopexy is performed 2-3 days following the procedure if cryotherapy is not performed. Laser laser is performed in the office under topical anesthesia.
Patients may not travel to high altitudes or fly when they have a gas bubble in the eye. The gas bubble expands rapidly in high altitudes causing high eye pressure and blindness.
Pars plana vitrectomy is an outpatient surgery which may be performed under twilight anesthesia (monitored anesthesia care) or general anesthesia. Three small ports (approximately 1/2mm in width) are placed into the white of the eye. The vitreous (gel) is removed. All retinal tears are relieved of any traction (pulling force) by the vitreous. The fluid between the retina and wall of the eye is removed and laser therapy is applied around the retinal tear. A gas bubble or silicone oil oil is then placed in the eye. The patient is asked to maintain a specific head position for 5-10 days.
Scleral Buckle is an outpatient surgical procedure which is typically performed under general anesthesia. A silicone band or sponge is used to indent the outer wall of the eye towards the retinal hole. The apposition of the outerwall of the eye against the retinal hole prevents fluid from entering the retinal hole, and thus causes the retinal to reattach. Cryotherapy (freezing therapy) is typically applied to the retinal tears at the time of scleral buckling surgery. Occasionally, scleral buckling surgery may be performed at the same time as a pars plane vitrectomy.
The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the procedure. It is up to the judgement of the physician to weigh the benefit of the procedure to the potential risks. It is only once the decision is made that the benefits outweigh the potential risks is the procedure offered to the patient.
Pneumatic retinopexy is reported to be successful in repairing retinal detachment approximately 75% of the time. Amongst those who do not have successful repair of retinal detachment with pneumatic retinopexy, the final success rate of retinal detachment repair with another procedure is approximately 97%.
The most significant risk of pneumatic retinopexy is failure of the procedure to repair the detachment. In this case, another procedure, such as pars plans vitrectomy and/or scleral buckle is typically required.
There is a small risk of infection following the procedure. If this is going to occur, it typically occurs 3-5 days following the procedure. Symptoms include redness around the eye that gets worse not better, extreme light sensitivity, and worsening pain. This is a medical emergency and requires immediate treatment by a retina specialist.
All procedures are associated with a number of other uncommon, but possible problems. Potential complications of pneumatic retinopexy include cataract formation, high eye pressure, bleeding within the eye, development of new retinal tears, proliferative vitreoretinopathy, and need for further procedures.
It is critical to the success of the procedure to maintain the positioning requested for 50 minutes per hour, 24 hours per day (including during sleep). Most physicians will recommend 1 week of positioning.
It is important to use eye drops as prescribed by your retina specialist. Patients may continue to use prescription eye drops (such as for glaucoma), unless otherwise told not to by their physician.
It is important to use eye drops as prescribed by your retina specialist. Patients may continue to use prescription eye drops (such as for glaucoma), unless otherwise told not to by their physician.
Peripheral vision – The peripheral vision should gradually become clearer. If the peripheral vision becomes dark and starts to become larger, this is a sign of a recurrent retinal detachment.
Infection – The eye should continue feeling better following surgery. Infection is characterized by a combination of severe eye pain, profound light sensitivity, and a decrease in vision. This must be treated emergently.
Traveling to high altitudes results in rapid expansion of the gas bubble and subsequent blindness. Patient may not travel to high altitudes until the gas bubble resolves.
Administration of nitric oxide for anesthesia may cause rapid expansion of the gas bubble and blindness. Patients should make their anesthesiologist aware they have a gas bubble in the eye if they are undergoing surgery.
This information is being provided to you for educational purposes only. Accessing or using this information does not constitute the practice of medicine nor does it establish a physician-patient relationship. This information does not replace a consultation with your eye care specialist. This information should be used at your own risk. The authors and Eye Know More do not assume any responsibility for harm incurred by the viewers. All information on the website is copyrighted and is the property of Eye Know More. Unauthorized redistribution of Eye Know More’s proprietary information constitutes a copyright violation.
