Diagnosis and treatment

Anaesthesia for your operation

Most operations for retinal detachments are performed under a local anaesthetic, which means you will be awake throughout your operation. We will inject local anaesthetic into the area around your eye to numb your eye and prevent you from feeling any pain during the operation. You will not be able to see details of what is happening, but you might be aware of bright lights or movement in the operating theatre.

During the operation, we will ask you to lie as flat as possible and keep your head still.

General anaesthesia, where you are asleep for the whole operation, is rarely used for retinal detachment surgery. If you require a general anaesthetic, you will need to follow specific instructions about eating and drinking prior to your operation.

Your operation 

Your surgeon will perform one of the following procedures to repair your retinal detachment:

1. Cryotherapy and scleral buckle: in cryotherapy and scleral buckle, we can seal retinal holes by applying ‘splints’ (buckles) on the wall of your eye. The buckle is made of sponge or solid silicone material. It is positioned, outside the white of the eyeball, under the skin of your eye and usually stays there permanently. 
2. Vitrectomy, cryotherapy and injection of gas, air or silicone oil: Vitrectomy operations are keyhole surgery for the eye. The surgeon makes tiny openings, less than 1mm across, in your eye and removes the vitreous from inside. Next, the surgeon finds the breaks in the retina and treats them with laser or cryotherapy (freezing). This causes an adhesion and scarring, which will seal the break. The seal usually takes ten days to form. We then put a gas bubble, air or silicone oil in your eye. This acts as a ‘splint’ to hold the retina in position until the tear is sealed. Vitrectomy operations are keyhole surgery for the eye. The surgeon makes tiny openings, less than 1mm across, in your eye and removes the vitreous from inside. Next, the surgeon finds the breaks in the retina and treats them with laser or cryotherapy (freezing). This causes an adhesion and scarring, which will seal the break. The seal usually takes ten days to form. We then put a gas bubble, air or silicone oil in your eye. This acts as a ‘splint’ to hold the retina in position until the tear is sealed.

If we put a gas, oil or air bubble in your eye you must not fly for the periods of time specified in the next page. This is because the gas or air bubble will expand in size and thus can lead to raised pressure inside your eye, leading to visual loss.

We use three types of gases:

• C3F8 which is long acting and can stay in your eye for up to 12 weeks
• SF6 which can stay in your eye for up to four weeks
• C2F6 which can stay in your eye for up to eight weeks.
• Air – which can stay in your eye for up to two weeks

You will be told after your surgery which type of gas or air bubble was used. 

You should not fly for two weeks after the insertion of silicone oil unless you have received clearance from your consultant. If we use silicone oil, we might need to remove this during a further minor operation several months after your first surgery. At the end of the operation, we may put small stitches on your eye and then put a pad and clear shield over your eye to protect it. The pad and shield will be removed the following morning and you only have to wear the clear eye shield at night-time for three weeks after your operation.

It is important to note that these can react with another gas called nitrous oxide, which can cause problems in your eye if any is administered. Nitrous oxide is commonly used during childbirth and in A&E as pain relief. Please tell the midwife or A&E staff treating you (or ask your family to) that you have gas in your eye and that they should not administer any nitrous oxide. Should you need a general anaesthetic for any reason during this time, it is important that you also tell the anaesthetist that you have had surgery and gas in your eye.

The benefits of retinal detachment surgery

The most obvious benefit is that the surgery prevents you from going blind. You have already lost some sight because of the detached retina. If the surgery is successful, it will usually bring back some, but not all of your sight. 

The risks of retinal detachment surgery

Retinal detachment surgery is not always successful. Every patient is different, and some detached retinas are more complicated to treat than others. Some patients might need more than one operation. Your surgeon will discuss with you the risks and benefits of the operation you are about to have.

Further surgery

If you fall into the 5-10% of people who develop another retinal tear or develop scar tissue, you will need to have more operations. When a retina is detached, the eye naturally tries to heal the damage. Instead of being helpful, this healing process leads to scar tissue forming inside the eye and the retina contracting. Your doctor might refer to this as ‘proliferative vitreoretinopathy’ or PVR for short. PVR is associated with poorer vision and can cause the retina to become detached again after successful surgery to reattach it.

Recovery

The treatment is performed under local anaesthetic to minimise discomfort and you usually won’t need to stay overnight in the hospital. Detached retina recovery generally takes between 2-6 weeks, but this varies depending on the individual and the specific case. It is normal to experience blurred vision after retinal detachment surgery. You may also have some redness and discomfort of your eye, for which you can take paracetamol. If your pain or blurred vision worsens after the operation, you should contact the hospital as you may require further treatment.

You may need to book time off work during your recovery and avoid driving for a while. Additionally, if a gas bubble was put into your eye as part of the retinal detachment treatment, you may be advised to avoid flying for fixed period of time.

After your operation

We will give you eye drops to reduce any inflammation and to prevent infection. We will explain how and when you should use them. Please don’t rub your eye as this may increase infection and lead to complications.

If you experience discomfort, we suggest that you take a pain reliever, such as paracetamol – take care not to exceed the dose stated on the packaging.

It is normal to feel itching and have sticky eyelids and mild discomfort (gritty sensation due to the stitches) in the operated eye for five to ten days following retinal detachment surgery. It is also common for some fluid to leak from around your eye. Occasionally, the area surrounding your eyes can become slightly bruised – this is especially common after a scleral buckle procedure. Any discomfort should ease after one to two days. In most cases, your eye will take about two to six weeks to heal. We will make an appointment for you to see your doctor again, usually within seven to 14 days of your operation. Try to rest while your eye is healing. 

Posturing

This is the hardest part of the recovery following your surgery, but the most important. If we put gas or silicone oil in your eye, we usually ask you to “posture” for up to seven days. This means lying or sitting in a position that keeps your head in a particular position (this is so that the bubble floats up and presses the retina into position while it is healing).

Your surgeon will advise you if it is necessary for you to posture, and in which position, after your surgery and will show you how to do this. As the gas bubble begins to disperse, you will notice a line in your vision that moves, similar to a spirit level. You will be able to see above the line, but under the line the vision will be fuzzy or blurred. The gas will eventually disperse until it is only a small bubble in the bottom of your eye and then the bubble will disappear too. The length of time the gas stays in your eye depends on which gas is used.

Your vision after surgery

After surgery, it usually takes some weeks for your vision to recover. If we used a gas bubble, your vision will be very blurred immediately after surgery.

This is normal and you should not be alarmed by it. Once the retina is attached, your sight will continue to improve slowly over several months.

You might be given sight tests to see if glasses would improve your vision. Your final vision will depend on the nature of your original detached retina. If we diagnose and treat it quickly and successfully, most of your central vision will be restored. If, the eye already has poor central vision, when we diagnose a detached retina, we might not be able to restore all of your central sight. You might not be able to read using the affected eye. From a distance, you might not recognise faces or be able to read car number plates, for example, but you will be able to see people and objects approaching you from the sides. Side vision is very important for day-today activities such as going out and climbing stairs.