Retinal Detachment - Treatment

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What is the treatment for retinal detachment?

Retinal holes or tears can be treated with laser therapy or cryotherapy (freezing) to prevent their progression to a full-scale detachment. Many factors determine which holes or tears need to be treated. These factors include the type and location of the defects, whether pulling on the retina (traction) or bleeding is involved, and the presence of any of the other risk factors discussed above. Three types of eye surgery are done for actual retinal detachment: scleral buckling, pneumatic retinopexy, and vitrectomy.

Scleral buckling

For many years, scleral buckling has been the standard treatment for detached retinas. The surgery is done in a hospital operating room with general or local anesthesia. Some patients stay in the hospital overnight (inpatient), while others go home the same day (outpatient). The surgeon identifies the holes or tears either through the operating microscope or a focusing headlight (indirect ophthalmoscope). The hole or tear is then sealed, either with diathermy (an electric current which heats tissue), a cryoprobe (freezing), or a laser. This results in scar tissue later forming around the retinal tear to keep it permanently sealed, so that fluid no longer can pass through and behind the retina. A scleral buckle, which is made of silicone, plastic, or sponge, is then sewn to the outer wall of the eye (the sclera). The buckle is like a tight cinch or belt around the eye. This application compresses the eye so that the hole or tear in the retina is pushed against the outer scleral wall of the eye, which has been indented by the buckle. The buckle may be left in place permanently. It usually is not visible because the buckle is located half way around the back of the eye (posteriorly) and is covered by the conjunctiva (the clear outer covering of the eye), which is carefully sewn (sutured) over it. Compressing the eye with the buckle also reduces any possible later pulling (traction) by the vitreous on the retina.

A small slit in the sclera allows the surgeon to drain some of the fluid that has passed through and behind the retina. Removal of this fluid allows the retina to flatten in place against the back wall of the eye. A gas or air bubble may be placed into the vitreous cavity to help keep the hole or tear in proper position against the scleral buckle until the scarring has taken place. This procedure may require special positioning of the patient's head (such as looking down) so that the bubble can rise and better seal the break in the retina. The patient may have to walk, eat, and sleep with the head facing down for 1 to 4 weeks to achieve the desired result.

Pneumatic retinopexy

Pneumatic retinopexy is usually performed on an outpatient basis under local anesthesia. Again, laser or cryotherapy is used to seal the hole or tear. The surgeon then injects a gas bubble directly inside the vitreous cavity of the eye to push the detached retina against the back outer wall of the eye (sclera). The gas bubble initially expands and then disappears over 2 to 6 weeks. Proper positioning of the head in the postoperative time period is crucial for success. Although this treatment is inappropriate for the repair of many retinal detachments, it is simpler and much less costly than scleral buckling. If pneumatic retinopexy is unsuccessful, scleral buckling still can be performed.


Certain complicated or severe retinal detachments may require a more complicated operation called a vitrectomy. These detachments include those that are caused by the growth of abnormal blood vessels on the retina or in the vitreous, as occurs in advanced diabetes. Vitrectomy also is used with giant retinal tears, vitreous hemorrhage (blood in the vitreous cavity that obscures the surgeon's view of the retina), extensive tractional retinal detachments (pulling from scar tissue), membranes (extra tissue) on the retina, or severe infections in the eye (endophthalmitis). Vitrectomy surgery is performed in the hospital under general or local anesthesia. Small openings are made through the sclera to allow positioning of a fiberoptic light, a cutting source (specialized scissors), and a delicate forceps. The vitreous gel of the eye is removed and replaced with a gas to refill the eye and reposition the retina. A scleral buckle is often also performed with the vitrectomy. The gas eventually is absorbed and is replaced by the eye's own natural fluid. In more complicated cases, a silicone oil maybe placed in the vitreous cavity instead of a gas. This oil must be removed at a later date.

Return to Retinal Detachment

See what others are saying

Comment from: Effie, 25-34 Female (Caregiver) Published: November 26

My niece had a silicone bubble placed to hold her retina in place. She has already lost her right eye and now she is saying that she cannot see at night. Her surgery for retinal detachment was about 15 years ago and from what I have been told the bubble can emulsify. Her sight is very limited, she also has cerebral or Erb's palsy. My sister is distraught and has asked me to research any possible solutions.

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Comment from: Bekinda, 55-64 Female (Patient) Published: March 29

I am 60. I've worn glasses since I was 8. At age 55 I had cataract surgery and also PRK (photorefractive keratectomy) surgery to correct nearsightedness. Vision was perfect with reading glasses for up close reading. February 2nd of this year I noticed a flashing light and severe headache. February 16th I awoke to partial vision in left eye. Immediately I went to the eye doctor. They sent me pronto to eye retinal surgery center. I had surgery 3 hours later. They did gas bubble. I went back next day for follow-up. They removed the patch and I started with eye drops. The first week, I had no sight. Then I started to notice a line top for sight. Above the line was clear, below it was like water. Each day the line got lower and lower. But when I moved my head the line moved making me sick to my stomach. At 2 week appointment the doctor said recovery was very well. At 2 1/2 weeks I noticed small black bubbles instead of line. But they still would move. Nauseating. Then at 3 weeks the small bubbles just disappeared. Sight is very good. Floaters and flashing are gone. At 6 weeks later my night vision is still weak. But every night I go outside and walk to increase sight. I go in 3 days for my last check-up. Very lucky.

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