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Treatments and drugs
By Mayo Clinic staffSurgery is used to repair a retinal tear, hole or detachment. Your ophthalmologist can tell you about the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.
Surgery for retinal tears
When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest an outpatient procedure, which can usually prevent retinal detachment and preserve almost all vision. Options include:
- Laser surgery (photocoagulation). During photocoagulation your surgeon directs a laser beam through a contact lens or ophthalmoscope designed for this procedure. The laser makes burns around the retinal tear, and the scarring that results usually "welds" the retina to the underlying tissue.
- Freezing (cryopexy). During cryopexy, your surgeon uses intense cold to freeze the retina around the retinal tear. After a local anesthetic numbs your eye, your surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect. This freezes the area around the hole, leaving a delicate scar that helps secure the retina to the eye wall.
After your procedure you'll need to remain relatively still for the next two weeks or so, as the bonds created by your procedure strengthen.
Surgery for retinal detachment
Doctors also use surgical procedures to repair retinal detachments. These procedures may be done in conjunction with photocoagulation or cryopexy. The type, size and location of the retinal detachment will determine which surgical approach your eye surgeon recommends. In general, these surgeries can successfully treat most cases of retinal detachment, although a second treatment is sometimes necessary.
Procedures include:
- Injecting air or gas into your eye. A procedure called pneumatic retinopexy involves injecting a bubble of air or gas into the vitreous. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of your eye. Depending on where the retinal detachment is located in your eye, you may need to hold your head in a certain position for several hours in order to keep the bubble in place.
- Indenting the surface of your eye. A procedure called scleral buckling involves suturing a piece of silicone rubber or sponge to the white of your eye (sclera) over the affected area. The silicone material indents the wall of the eye, relieving the tugging of the vitreous on the retina. When you have several tears or holes or an extensive detachment, your surgeon may create an encircling scleral buckle that goes around the entire circumference of your eye like a belt. The buckle usually remains in place for the rest of your life.
- Draining and replacing the fluid in the eye. A vitrectomy is a procedure to remove the gel-like fluid in the center of the eye, along with any tissue that is tugging on the retina. Air, gas or liquids are injected into the vitreous cavity to reattach the retina. A vitrectomy is often combined with a scleral buckling procedure.
Surgery isn't always successful in reattaching the retina. Also, a reattached retina doesn't guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery, and if it was, for how long. Your vision may take many months to improve after repair of a retinal detachment. Some people don't recover any lost vision.
- Facts about retinal detachment. National Eye Institute. http://www.nei.nih.gov/health/retinaldetach/retinaldetach.asp. Accessed Oct. 8, 2010.
- Wilkinson CP. Rhegmatogenous retinal detachment. In: Yanoff M, ed., et al. Ophthalmology. 3rd ed. Edinburgh, U.K.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/212799885-2/0/1869/0.html. Accessed Oct. 8, 2010.
- Arroyo JG. Retinal detachment. http://www.uptodate.com/home/index.html. Accessed Oct. 11, 2010.
- Posterior vitreous detachment, retinal breaks and lattice degeneration. San Francisco, Calif.: American Academy of Ophthalmology. http://one.aao.org/asset.axd?id=99eddbb5-cf3e-4619-a411-887961b738a2. Accessed Oct. 8, 2010.
- Fletcher EC, et al. Retina. In: Riodan-Eva P, et al. Vaughan & Asbury's General Ophthalmology. 17th ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=19. Accessed Oct. 8, 2010.
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