Laser can be performed to repair
a retinal detachment as well as to prevent one. Only small,
very localized retinal detachments can be repaired by laser.
The laser is applied around the retinal defect and area
of detachment. The encircling laser photocoagulation
bond prevents any more fluid from seeping through the retinal
defect and causing the detachment to expand. Once the retinal
adhesion has formed there will be a tiny focal area of vision
loss in the area of treatment but the patient is spared further
detachment and more complicated intraocular surgery. Typically
this procedure is performed in the office setting.
retinopexy is a combination of focal laser treatment as described
above along with another procedure of injecting an expanding
gas bubble into the vitreous cavity.
These procedures are generally carried out in two consecutive
days. It may be done in an office setting or as same day hospital
outpatient surgery with local anesthetic or light general sedation.
The gas is injected into the eye by syringe with a very fine
short needle. Once in the eye, the gas expands to cover
the area of retinal detachment and the retinal defect. It
helps to close the retinal defect and the subretinal fluid to
resorb. While the bubble is in the eye, most of the time
less than 2 weeks, patients will be instructed to position his
or her head in a manner that allows the bubble to float to the
area of detachment.
Scleral buckling is the most
common and traditional method of repairing a significant rhegmatogenous
retinal detachment. It is an outpatient hospital
procedure performed under general anesthesia. The buckle
is a piece of silicone that is placed on the exterior of the
globe corresponding to the retinal defect on the interior of
the eye. The buckle is sewn onto the sclera to indent
the retina inwards towards the interior vitreous cavity so that
the retinal defect is closed and supported. The defect
may be sealed externally by cryo (freezing treatment) or with
laser photocoagulation interiorly.
Vitrectomy is the surgical method
of evacuating the vitreous gel from inside the vitreous cavity.
Vitrectomy is used alone for some conditions, for example
removing the vitreous of a patient who has experienced hemorrhaging
into the interior of the eye. The blood in the vitreous that
obscure vision is removed with the vitreous fluid. Vitrectomy
is a component of complicated retinal detachment repair. Scleral
buckling and vitrectomy and laser and injection of an expandable
gas or silicone oil vitreous substitute
may all be carried out in combinations for complex detachments
that have proliferative vitreoretinopathy (PVR).
Traction retinal detachments seen in diabetes
is an example of complicated detachment with PVR. Complicated
detachments with scarring membranes,PVR, can result from other
conditions including serious eye trauma, Cytomegalovirus "C.M.V."
retinitis a complication of AIDS, and other conditions. Sometimes,
for some people, PVR can be associated with rhegmatogenous retinal
is often performed in conjunction with retinal detachment repair
of complex detachments to protect against future detachments
in the eye which has already experienced detachment.