Scleral buckling surgery
Retinal detachment is a serious eye problem that causes blindness if not treated. Fortunately, surgery is successful in more than 90% of cases. Scleral buckling surgery is a common method of treating retinal detachment. This technique closes breaks in the retina and flattens it.
The retina is the nerve tissue that lines the back wall of the eye. Much like the film in a camera, the retina is sensitive to light. It transforms light energy to nerve stimuli, and “sends a picture” through the optic nerve to the brain.
The retina normally rests against the choroids, a layer of blood vessels which supplies the retina with nourishment. When the retina becomes separated (detached) from the choroids, it no longer receives its normal blood supply and is unable to function properly.
The result is visual loss. The amount of visual loss depends on the location and extent of the detachment. If the center of the retina, the macula, is detached, patients usually report significant decrease in visual acuity and loss of the ability to read. If the detachment is occurring in the peripheral retina, the patient may be unaware of its presence except for noticing a black curtain, veil or shadow coming from some portion of side vision when the eye is individually tested.
The eye is filled with a clear jelly-like substance called the vitreous gel. Normally, the retina receives support from this gel. A normal aging change of the vitreous gel causes it to liquefy and separate into two portions: a gel portion and a watery portion. This change occurs earlier in nearsighted eyes and following inflammation or eye surgery. Sometimes the gel portion can rapidly shift forward and tug on the retina. In some areas, the vitreous attachment to the retina may be strong. In these areas of vitreoretinal traction, the bond may be so strong that the pulling way of the vitreous gel from the retina causes a tear at the point of adherence. Fluid from the vitreous cavity can then pass through the new hole in the retina and allow the retina to separate from the choroids, much like wallpaper peels from a wall.
Retinal detachments are usually repaired with an operation called scleral buckling. The holes and tears are first sealed using either cryotherapy (freezing) or laser photocoagulation. Either of these procedures are used to cause a controlled scarring of the area surrounding the hole/tear, sealing the area, and preventing any more fluid from getting beneath the retina and causing further detachment. The fluid already present under the retina may be drained or depending on the individual case may be left to absorb slowly by itself. Then, in order to bring the retina back against the wall of the eye, a soft silicone material is sutured to the outside of the eye wall (the sclera). This creates an indentation or “buckle.”
Surgery takes 1 to 3 hours to complete, depending upon the complexity of the detachment. The surgery is usually performed under local anesthesia. An anesthesiologist is always present in the operating room to monitor EKG, blood pressure, and breathing, and to administer sedatives to ensure the comfort and relaxation of the patient during surgery. There is also any assistant surgeon present. (Talk with our staff about whether the assistant surgeon’s services are covered by your insurance.)
It may be necessary to consult with an internist before your surgery to make sure you are in satisfactory condition for the operation. Blood tests, an electrocardiogram and chest X-ray may be ordered. Our office staff will make the arrangements for these tests with the hospital. (Speak with our staff about how a separate bill will be sent by the doctor, laboratory, or hospital where these services are performed to your insurer.)
On the day of surgery, do not eat or drink anything unless specific instructions are given to the contrary. Do take your regular medications the day of surgery with a sip of water. If you take insulin for diabetes, ask our office staff about instructions for the day of surgery.
The eye that has been operated on will be covered with an eye patch. Some degree of discomfort is to be expected, but Tylenol or Advil is usually sufficient to relieve it. Call the office if the pain is more severe. Most patients are discharged within a few hours following the surgery. An office visit will be scheduled for the day following the surgery.
Following successful retinal surgery, vision will be quite blurred at first and improve very gradually over a period of many months. Just how well you will be able to see depends upon the complexity of the problem before surgery and your body’s own capacity for healing. Be patient with your eyes and try not to expect too much too soon!
An office appointment will be scheduled for the day following surgery. Several types of eye drops will be prescribed at this appointment. You may need additional drops or ointments depending on you individual case.
If a gas bubble was placed in the eye during surgery, it may be necessary to keep your head in a given position for several days. Your physician will give you specific instructions if this was part of your surgery.
Your eye will be red, watery, and feel uncomfortable when you leave the hospital. These side effects will clear up over two to three weeks. If the redness worsens, the discharge becomes yellow or green, and/or the eye becomes very painful, contact our office so you can be checked immediately for infection.
Vision will be poor immediately following surgery and should then show gradual improvement. Any sudden and severe drop in vision form its level immediately following surgery should be promptly reported and evaluated in the office.
In most cases, the patch is necessary for only one day after surgery. However, if the patient feels more comfortable wearing a patch, it is not harmful wear the patch for more than one day.