The eye works like a camera. It has two parts, a lens and a film. The film layer lines the back wall of the eyes and is called the retina. The area responsible for the central vision is called the macula. There is a gel called the vitreous which is very firmly adherent to the retina. The vitreous separates from the back of the eye towards the front of the eye as a normal part of aging. The vitreous can pull firmly enough on the retina during the separation process that a small piece of retina is torn. Fluid then migrates through the hole and begins to detach the retina from the wall of the eye. This is called a retinal detachment.
Your doctor has discovered a retinal tear which has allowed fluid to migrate underneath the retina, including the area of central vision. Patients will typically report that the vision is blurry and distorted.
Your retina specialist recommends an outpatient surgery called a pars plana vitrectomy for treatment of the retinal detachment. The goals of treatment are several fold: Repair the retinal detachment and improve the vision.
Patients will usually notice a substantial improvement in their vision following recovery from surgery. The amount of improvement varies. Most patients will continue to notice some blurriness in the central vision and distortion after surgery. The blurriness usually improves quickly over a month or two, and continues to slowly improve thereafter. Distortion takes months to improve, and in many patients, does not resolve completely. The vision usually improves, but does not return to the quality of vision prior to experiencing a retinal detachment.
Retinal detachment repair has a 90 percent chance of success with one surgery. Ten percent of the time, the retina may redetach requiring additional surgery. Patients may optimize their chance of success with one surgery by following the surgeons post-operative instructions.
Pars plana vitrectomy is an outpatient surgical procedure which is performed in the operating room. It may be performed under twilight (awake, relaxed, and no pain) or general anesthesia. The retina specialist performs the surgery by placing three half-millimeter ports into the white of the eye. The gel, pulling forces acting on the retina, and fluid between the wall of the eye and retina are removed. Laser therapy is used to form scar tissue around the retinal tears and prevent retinal redetachment. Laser therapy takes 5-7 days to have its full sealing effect.
The gel that is removed is replaced with a self-absorbing gas bubble. The gas bubble is buoyant and floats upwards. The purpose of the gas bubble is to cover the retinal tears while the laser is healing. Your retinal specialist will instruct you on how to position following surgery to best cover the retinal tears. The positioning requirements are typically 50 minutes of every 1 hour, 24 hours per day, for 5-7 days. Requirements vary by surgeon and detachment.
It is important to be aware that patients are unable to fly or travel to high altitudes with a gas bubble in the eye. Doing so will result in a rapid increase in eye pressure and permanent blindness.
There are two different types of self-absorbing gas: SF6 and C3F8. SF6 lasts approximately 2 weeks and C3F8 lasts 6-8 weeks. The choice of gas depends on the configuration of the retinal detachment
Patients will have an eye patch and eye shield placed over their eye after surgery. They will be instructed on how to correctly position. The eye patch and eye shield are removed by the ophthalmic technicians at the post-operative one day visit. Most patients notice the vision is very blurry the day following surgery. The areas that were once dark are usually full, but blurry. It is not possible to see clearly through a gas bubble. Patients may notice a clear area at the top of their vision which represents the area of retina not covered by the gas bubble. This will become larger over time until the gas bubble no longer covers the area of central vision. At this point, the central vision will slowly become clearer. The process will occur until the gas bubble resolves completely.
Patients are unable to drive immediately after surgery or the following day. It is safest to avoid driving as much as possible until the gas bubble resolves. Most retina specialists will ask patients to avoid lifting greater than 20 pounds for at least two weeks.
The biggest risk of retinal detachment repair is the risk of retinal redetachment. This occurs in approximately 10 percent of cases. Retinal redetachment usually occurs due to an exaggerated healing response by the eye which results in the formation of scar tissue around 6 weeks following retinal detachment repair. Patients who already have scar tissue prior to retinal detachment repair are even more likely to develop additional scar tissue causing retinal redetachment.
Patients who have not yet had cataract surgery will experience a worsening in cataract formation. Ninety percent of patients who are 50 years and older will undergo cataract surgery within 2 years of retinal detachment repair.
The main sign of retinal redetachment is the development of a black curtain in the vision which is similar to the initial retinal detachment symptoms. Patients who experience such symptoms should contact their retina specialist.
The most important action patients may take to optimize the likelihood of success is to perform an excellent job with positioning.
Please discuss any additional questions or concerns with your eye care specialist.
