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Questions and Answers - Retinal Detachment and Vitreous Surgery

What is the purpose of retinal detachment surgery?
When the retina is detached, it cannot function properly and vision is lost.  The purpose of the surgery for retinal detachment is to reattach the retina.  If the surgery is successful, the vision will usually improve.  The final vision depends greatly on whether the macula was detached.

If pneumatic retinopexy does not work, may I then undergo the scleral buckling procedure?
If pneumatic retinopexy fails to reattach the retina, the patient usually can undergo a scleral buckling procedure.

Does the silicone scleral buckle ever need to be taken off?
Once a scleral buckle is sutured onto the wall (sclera) of the eye, it stays in position forever.  It may slightly change the shape of the eye, it stays in position forever.  It may slightly change the shape of the eye and, after the eye has healed, a new pair of glasses may be necessary.  On rare occasions, a scleral buckle placed all the way around the eye may cause pain.  If the pain is severe and cannot be relieved with medicine, it may be necessary to loosen or remove the buckle.  Rarely, an infection may occur.  In such instances, the buckle may need to be removed from the eye.  When the buckle is removed, the retina usually remains attached, but may detach.  In most cases, however, the scleral buckle remains against the eye forever and causes no serious problem.  It cannot be seen by others.

How is vitrectomy surgery performed?
The surgery is performed using local or general anesthesia.  Vitrectomy surgery is performed through an operating microscope, which allows the surgeon to look through the dilated pupil at the retina.  Small openings through the sclera are made in order to insert vitrectomy instruments into the eye.  A variety of instruments is used, including a fiberoptic light which lights the inside of the eye, and a variety of vitreous cutters, scissors, and forceps.

How long will the vitreous or retinal surgery take?
The length of the surgery depends on the type of problem you have.  If you have an epiretinal membrane or uncomplicated retinal detachment, surgery can take less than an hour.  However, if the eye needs to have the lens removed, a scleral buckle placed, and scar tissue removed from the eye, the surgery could take two to three hours.

What are the possible complications of vitrectomy surgery?
There are risks to any surgery.  The risks must be outweighed by the benefits if surgery is to be performed.  Cataracts occur as a side effect of vitrectomy surgery in almost every case.  The risks include the development of a tear in the retina, glaucoma, double vision, bleeding into the eye, infection or redetachment of the retina.  Sometimes, thought the retina may remain attached, the pressure inside the eye may not be adequate to keep the eye "inflacted" to its normal size.  The eye may become shrunken and need to be removed.  Any one of these complications may result in severe loss of vision, or even the loss of the eye itself.

How long will I be in the hospital for my surgery?
You will probably be admitted to the hospital the day of surgery.  Usually patients may leave the hospital the same day, but sometimes a patient may stay overnight.

Are there risks to general anesthesia?
General anesthesia always carries a degree of risk.  Minor risks include postoperative nausea, vomiting, and hiccuping.  Some patients experience an upset stomach following surgery.  If nausea does develop, it can be controlled with medication.  Occasionally, patients will experience some confusion and prolonged sleeping.  Very rarely, serious reactions occur that result in liver failure, cardiac arrest, and even death.

Will my eye hurt after surgery?
You may note some discomfort around the eye, but severe pain is unusual.  Discomfort can be relieved with medication if necessary.  Your eye will remain swollen, red, somewhat tender, and uncomfortable for several weeks.  You may also notice scratchy, foreign body sensation when opening or closing the eye.  This is caused by small stitches on the outside of the eye.  These stitches will gradually become soft and fall out, probably within two weeks.

What instructions must I follow when I go home after surgery?
The amount of physical activity that is allowed depends on the type of surgery that you have had.  Your surgeon will discuss with you any restrictions.  You will be asked to use some eye medications when you go home.  The purpose of the drops is to prevent infection and make the eye more comfortable as it heals.

Will I see better right after surgery?
The vision following surgery depends on the type of surgery that you have had.  In general, it takes a long time for you to reach your best vision.  The vision in the eye will almost certainly be blurry for many weeks.  Your surgeon will discuss with you the chances of visual recovery following your surgery and how much vision you can hope to regain.  It is important to realize that recovery of vision following any type of retinal or vitreous surgery takes a long time.

Why is postoperative head positioning important and how long must it continue?
Patients are asked to remain in a certain position after surgery (usually face-down) if they have air, gas, or silicone oil in they eye.  These materials rise to the highest point in the eye.  If there have been retinal tears that have received laser or cryotherapy during surgery, the air, gas, or oil can help keep the tear closed, and the retina attached, while the laser or cryotherapy takes hold.  Occasionally, head positioning is used to allow blood in the eye to settle away from the macula.  The length of time varies, and your surgeon will tell you when it is safe to stop this special positioning.

Is is possible that I may not see after surgery?
Despite our increasing knowledge about retinal detachment and vitreous disease, and despite the sophisticated surgical equipment and techniques that we bring into the operating room, it may be impossible to improve a patient's vision.  The chance for blindness with severe retinal disease is real.  When considering surgery, the patient and the doctor must weigh the risks, including the possibility of total blindness, against the possible benefits of either stabilizing or improving vision.   It is important for the patient to know that surgery may fail due to complications, or simply due to the progressive nature of the retinal disease.

Is there a time when an eye is too hopelessly damaged to consider surgery?
This is a difficult question.  Whether to perform any surgery depends on whether the patient feels that the benefits of the surgery are worth the risks.  The decision will be different for every patient, since every patient's needs are different.  If an eye is badly damaged, there may not be much to gain with surgery, and  a patient might decide not to have surgery.  If however, the patient may decide not to have surgery.  If, however, the patient has only one eye, then any vision that is saved will be tremendously important.   No two patients, and no two retinal problems, are alike.  Your surgeon will help you understand when you can hope to gain with surgery, and what you risk to lose.