Also called as
Scleral buckling
Vitrectomy
Pneumatic retinopexy
Laser retinopexy

Definition   
             Retinal detachment repair is eye surgery to place a detached retina back into its normal position. A detached retina means the light-sensitive tissue in the back of the eye has separated from its supporting layers.

Detached retina
                                       
              As a result of injury, tumors, or disease, the retina can become completely or partially detached causing diminished vision. The retina can be repaired by laser, cryo-probe, or surgery.

Description   
             repair of detached retina are mostly emergency  operations. A detached retina lacks oxygen, which causes cells in the area to die. This can lead to blindness.  If holes in the retina are found before a detachment occurs, an opthalmologist can close the holes using a laser. This is usually done in the doctor's office. If the retina has just started to seperate, a procedure called pneumatic retinopexy may be done to repair it. Pneumatic retinopexy (gas bubble placement) is also usually an office procedure. The health care provider injects a bubble of gas into your eye. You will be positioned so the gas floats up against the hole in the retina and pushes it back into place. The surgeon will use a laser to permanently seal the hole.  More severe detachments require more advanced surgery.

There following procedures are done in a hospital or outpatient surgery center:

• The scleral buckle method bends the wall of the eye inward so that it meets the hole in the retina. Scleral buckling can be done under local or general anesthesia
• The vitrectomy procedure uses very small instruments inside the eye to pull the retina forward. Most vitrectomies are done under local anesthesia.

For some complex detachments, both procedures may be done during the same operation.

Purpose of surgery
             Retinal detachments do not improve without treatment. Repair is necessary to prevent permanent vision loss. The urgency of the surgery depends on the location of the detachment. If the detachment has not affected the central vision area (the macula), surgery should be done quickly, usually the same day. This is necessary to prevent further detachment of the retina. If the macula detaches, the surgery can still be done, but the visual result will not be as good. If the macula has already detached, there is less urgency. Surgeons can wait a week to 10 days to schedule surgery.

Risks   
Risks for retinal detachment surgery may include:

• Detachment not completely fixed (may require additional surgeries)
• Increase in eye pressure (elevated intraocular pressure)
• Bleeding
• Infection

General anesthesia may be required. The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Post operative
             The chances of successful reattachment of the retina depend on the number of holes, their size, and whether there is scar tissue in the area.
             Most of the time, the retina can be reattached with only one operation, although some people need several surgeries. Less than 10% of detachments cannot be repaired. Failure to repair the retina always leads to poor or no vision in the eye.

After surgery, the quality of vision depends on where the detachment occurred:

• If the central area of vision was not involved, vision will usually be very good.
• If the central area of vision was involved for less than 1 week, vision will usually be improved, but not 20/20 (normal).
• If the central area of vision was detached for a long time, vision will return, but it will not be sharp.

Prognosis   
              The procedures usually do not require an overnight hospital stay.
You will need to limit activities for some time.
             If the doctor repaired the retina using the gas bubble procedure, you must keep your head face down or turned to one side for several weeks. It is important to maintain this position so the gas bubble pushes the retina in place. Patients with a gas bubble in the eye may not fly.

Surgical procedures:
Retinal detachment repair 1              The most common technique used to repair retinal detachment is called a scleral buckle. Prior to performing a scleral buckle procedure, breaks and tears in the retina are closed. There are two major methods used to close breaks and tears in the retina. Cryopexy, uses an intensely cold probe (cryoprobe). This produces an inflammation that leads to formation of a scar which holds the retina to the underlying tissue.

Retinal detachment repair 2
             A laser treatment (photocoagulation) can also be used to seals holes in the retina. The choice of cryopexy or photocoagulation is usually determined by the preference of the surgeon-both procedures are equally effective in most cases.

Retinal detachment repair 3              After sealing breaks and tears in the retina with either laser or cryoporbe treatment, the scleral buckle is applied. This consists of a silicone patch wrapped around the eye, compressing the globe and elongating it slightly, thus pushing the retina up against the posterior aspect of the eye, and sealing the detachment. The silicone patch is usually left in place permanently, unless it causes problems later, such as infection.

Retinal detachment repair Aftercare              Scleral buckling for detachment may require a few days in the hospital. Keep the head elevated at all times. Patients should not bend over or strain with lifting or bowel movements. Vigorous exercise should be avoided for 3 to 4 weeks

Reference: MedlinePlus

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