¿Qué es el desprendimiento de retina?

Retinal detachment surgery

Foto de desprendimiento de retina que afecta la mácula

Surgery for retinal detachment must be performed as soon as possible mainly due to two reasons. First, because the disease may advance rapidly, leading to more visual loss. And second, because while the retina is detached it becomes progressively more damaged, which reduced the chances of recovering sight after treatment. For more information on retinal detachment (symptoms, causes, consequences), read here.

Retinal detachment surgery must be tailored to each case since there are three different surgical procedures, each with its own advantages and drawbacks. The choice of surgical technique depends on the extension of the retinal detachment (how much retina has become separated from the inner eyewall), the age of the patient, whether there have been previous eye surgeries for other diseases, and other factors. The three surgical procedures have the same aim: to restore the retina to its proper position within the eye and to fix it there permanently by different means.

1. Pneumatic retinopexy

One of the surgical procedures is called pneumatic retinopexy and involves the injection of special gas into the eye (which creates a gas bubble) and applying intense cold (cryotherapy) or laser from outside the eye over the area where the retina has broken (retinal break). This is the least invasive of the three procedures, but there are limitations that preclude its use for many retinal detachment cases. In my practice, less than 5% of the presenting cases can be treated by pneumatic retinopexy.

2. Scleral buckling

The second type of procedure is scleral buckling, which consists of placing a tightening silicone band around the eye (hence the name buckle) to bring the eyewall closer to the detached retina and then applying intense cold (cryotherapy) from the outside of the eye over the area of broken retina. Sometimes, a gas bubble is injected into the eye to aid the reattachment process. I resort to this technique in about 10-15% of my cases. Scleral buckling has some advantages for younger patients and particularly for some types of retinal detachment, which are more likely to resolve with this technique.

3. Vitrectomy (educational video)

Vitrectomy is the third surgical option, and the most commonly performed nowadays. It is the most complex of the three procedures and the one with the most important surgical advances in recent years. Vitrectomy consists of making three microincisions in the front part of the sclera (white part of the eye), and through them, then removing the vitreous body that pulls the retina away from the inner eyewall, then drain the liquid that sifted under the detached retina, and finally sealing the retinal breaks with laser applied from within the eye. At the end of the procedure, the eye is filled with either gas or silicone oil. I resort to vitrectomy in 80-85% of my cases. This technique may also be performed in combination with the second procedure, scleral buckling, an approach generally reserved for the more complex or advanced cases.

Whenever intraocular gas is used for any of the three techniques, the gas bubble remains in the eye only for 2 to 8 weeks (depends on the type and amount of gas injected) while it is slowly eliminated through breathing and eye tissues. By contrast, when silicone oil is used as a tamponade agent, it must be removed by an additional surgical procedure. Silicone oil extraction is usually done at least three months after the first procedure, depending on how the retina evolves. 

Anesthesia, surgical procedure, and postoperative recovery

Most surgeries for retinal detachment are done under local anesthesia. There are many advantages to the use of local anesthesia such as avoiding the greater risks of general anesthesia (which are low in and of themselves but do exist), the quick recovery, and the outpatient surgery (no admission is required before or after the intervention). The procedure is done with sedation, which varies in extent according to the needs of the case and the wish of the patient. In some cases, like children, general anesthesia is required.

The surgical procedure lasts between 30 minutes and 2 h, depending on the technique, whether one or a combination of procedures is performed, and the complexity of each case. During the surgery, a tamponade agent, which can be either intraocular gas or silicone oil, is injected into the eye (read more).

After the procedure, the patient is usually instructed to remain in a given position so as to improve the chances of success and to decrease potential visual impairment (read more).