Retinal Detachment Repair With a Scleral buckle - Everything You Need To Know To Maximize Your Results

Take the 5 Steps

Step 1 – Learn the basics of retinal detachment

Step 2 – Learn about the surgery 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

LEARN THE BASICS ABOUT RETINAL DETACHMENTS

How the Eye Works - The Basics

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.

Retinal Detachment - Understand Why it Happens

There are two main mechanisms for the development of a retinal detachment. In older patients, it typically happens due to a seperation of the vitreous (gel) 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.

Younger individuals may experience progressive thinning of the retina (lattice degeneration) with the development of full-thickness holes in the retina. These retinal holes may also result in the formation of a retinal detachment.

In both the young and old, full thickness retinal holes allow the movement of liquid vitreous to pass through the holes and create a retinal detachment. 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.

Learn About The Surgery and What To Expect

The placement of a scleral buckl is a surgical procedure which is performed in the operating room. It is most commonly performed under general anesthesia.

There are numerous methods to placing a scleral buckle. The fundamental process is the isolation of all of the rectus muscles (muscles which control eye movement). The retina specialist identifies the retinal tears. Either a silicone band or sponge is placed overlying the retinal tear to indent the wall of the eye towards the retinal tear. The surgeon may choose to make a small incision in the outer wall of the eye to drain the fluid between the retina and the outer wall of the eye. Cryotherapy (freezing) or laser treatment is applied around the retinal tears. The surgeon may potentially inject a self-absorbing gas bubble into the eye. If a gas bubble is injected into the eye at the time of surgery, it lasts between 2-6 weeks. The patient has a patch and shield placed on the eye at the end of surgery. The vision is typically very blurry the first day following surgery, but usually gradually improves over the weeks to months.

If a gas bubble is injected, it is worth noting that there are two different types of self-absorbing gas: SF6 and C3F8. SF6 typically lasts approximately 2 weeks and C3F8 approximately 6-8 weeks. Patients will notice a clear area at the top of their visual field which represents the area of retina not covered by the gas bubble. This area 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. This process will occur until the gas bubble resolves completely. The central vision is typically decreased or distorted if it was affected by the retinal detachment. This typically improves slowly over a period of several months.

It is not possible to see through the gas bubble. The gas bubble will resolve over a period of several weeks. The central vision will become clearer (if pre-operatively involved by the retinal detachment) over several weeks to months. If the central vision is not involved, the primary visual improvement will be an improvement in the peripheral vision whch was previously affected by the retinal detachment.

Patients will typically notice moderate pain with eye movement following scleral buckle surgery. This is because the scleral buckle sits underneath the eye muscles. The discomfort is usually the most severe during the first week, then improves considerably. A small percentage of patients may note double vision following surgery. Double vision usually resolves completely. It may persist in a very small percentage of patients resulting in the need for scleral buckle removal several months after surgery.

Scleral buckle placement typically causes a change in the prescription of the eye, resulting in additional myopia (more difficulty seeing far way).

A benefit of scleral buckle surgery is the fact that most patients have no positioning requirements. Only patients whom have a gas bubble injected are required to maintain a particular position. The absence of a gas bubble also means that patients may travel to high altitude or fly (this will result in blindness if a gas bubble is in the eye).

Step 3 - Learn About the Other Options

Pars Plana Vitrectomy

Pars plana vitrectomy is an outpatient surgery which may be performed under twilight anesthesia (monitored anesthesia care) or general anesthesia. 3 small ports (approximately 1/2mm in width) incisions are made 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.

Pneumatic Retinopexy

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.

Step 4 - Understand the risks of a scleral buckle

The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the surgery. 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.

Scleral buckle is reported to be successful in repairing a retinal detachment with one surgery approximately 85% of the time. With more than 1 surgery, the success rate is approximately 95%. The rate of first time retinal reattachment with scleral buckling varies with the type of detachment. The risk of needing more than 1 surgery is higher for patients who have pre-existing proliferative vitreoretinopathy.

The most significant risk of scleral buckle surgery is failure of the procedure to repair the detachment. In this case, another surgery, such as a revision of the existing scleral buckle or pars plans vitrectomy (possibly with silicone oil) may be required.

Symptoms of retinal re-detachment include the sudden onset of many new floaters, new onset flashing lights, or noting a progressive decrease in the peripheral vision (like a curtain coming down at a play). This is urgent and the treating physician should be made aware the same day.

There is a small risk of double vision after the surgery. This can typically be treated by lacing prisms within the patients glasses. In some cases, an additional surgery may be required to address the double vision.

There is a small risk of extrusion of the scleral buckle. This is not typically painful, but noted simply as an area of elevation on the outside of the eye. This is typically addressed by removal of the silicone band.

There is a small risk of infection. This is typically treated with antibiotics, but in some cases, may require removal of the scleral buckle.

There are a number of other less common problems that may occur following scleral buckle surgery. This surgery is considered to be safe and well tolerated for most patients.

STEP 5 - MAXIMIZE YOUR RESULTS

Eye Drops

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.

Vision

The central vision will become clearer (if pre-operatively involved by the retinal detachment) over several weeks to months. If the central vision is not involved, the primary visual improvement will be an improvement in the peripheral vision whch was previously affected by the retinal detachment.

Discomfort

Many patients find that using a cold compress overlying their closed eye helps to decrease swelling and increase comfort. It is recommended to use a shield on the eye for the first week while sleeping.

Warning signs

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.

Things To Know if a Gas Bubble Has Been Placed in the Eye

No Flying or High Altitudes

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.

Anesthesia

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.