RETINAL DETACHMENT SURGERY – PARS PLANA VITRECTOMY

If your eye doctor has advised you to have a retinal detachment surgery, you must keep in mind that this procedure is considered a medical emergency. The retinal detachment must be treated quickly to stop it from permanently affecting your sight.

The surgery, called pars plana vitrectomy, seals the retinal holes and focuses on reattaching the retina to the inside of the eye.

WHAT IS A RETINAL DETACHMENT?

The retina is the light-sensitive layer of tissue at the back of your eye. It is in charge of receiving and transmitting light signals to your brain, where they are interpreted as images. A detached retina is when this thin layer becomes loose and is pulled away from its normal position.

In the case of retinal detachment, a hole or several holes develop in the retina, and fluid passes through them, causing the retina to peel away, just like a blister.

Written by Dr Osama Bahsas Zaky
Updated on November 29, 2021

What Is a Retinal Detachment?

The Causes.

The Symptoms.

How Is Retinal Detachment Diagnosed?

What Is the Treatment for Retinal Tears?

What Does Surgery Involve?

Pars Plana Vitrectomy.

Scleral Buckling.

Pneumatic Retinopexy.

Aftercare from Surgery.

The Recovery.

Surgery Risks.

What Causes Retinal Detachment?

Anyone can have a retinal detachment. It can happen due to aging (especially in patients over 60). But you are at higher risk if you’ve had a severe eye injury or eye surgery (e.g., cataract surgery) before.

Other conditions that may also put you at higher risk include:

  • Diabetic retinopathy. This condition affects the retina’s blood vessels, causing bleeding and scarring, which can pull on your retina.
  • Extreme nearsightedness (myopia), especially the one called degenerative myopia.
  • Posterior vitreous detachment (PVD), where the gel-like fluid inside the eye pulls away from the retina.
  • Other eye conditions, including retinoschisis (the retina separates in 2 layers) or lattice degeneration (thinning of the retina).

What Are the Symptoms of a Detached Retina?

If only a part of your retina has detached or you have a small tear, you may not have any symptoms. But in more severe cases, you may have blurry vision, and other symptoms, such as:

  • Small dark dots or lines (floaters) suddenly appear in your vision or increase in number.
  • Flashes of light in one eye or both eyes.
  • A “curtain” or shadow in the middle of the field of vision.

These symptoms may happen suddenly or over hours, days, or even weeks. If you experience them, call your eye doctor or go to the emergency room right away.

How Is Retinal Detachment Diagnosed?

To confirm the diagnosis, your eye doctor will check your eyes with a dilated eye exam. He will apply some eye drops to widen (dilate) your pupil and check for any retinal holes, tears, or detachments.

The doctor uses an instrument with a bright light and special lenses to examine the retina. This exam is painless. The doctor may also press on your eyelids to check for retinal tears, which may be uncomfortable for some patients.

Your eye doctor could order an ultrasound or an optical coherence tomography (OCT) scan of your eye. Both of these tests help to see the exact state of your retina.

What Is the Treatment for Retinal Tears?

When a tear in your retina hasn’t yet progressed to detachment, you can have less invasive procedures to seal the tear using laser or cryotherapy.

With laser surgery (photocoagulation), the surgeon focuses a laser beam into the eye through the pupil. The laser makes small burns near the retinal tear, creating an eye scar that “welds” the retina to the underlying tissue.

In the case of a freezing treatment (cryopexy), the eye surgeon applies a freezing probe to the outer eye surface, directly over the tear. The freezing causes retinal scarring that secures the retina to the posterior eyewall.

Both of these procedures are performed on an outpatient basis in the eye doctor’s office.

WHAT DOES SURGERY FOR RETINAL DETACHMENT INVOLVE?

If a more significant part of your retina is detached, you may need surgery to place it back to its original position. If you have surgery on time, your vision might be as good as it was before. The longer your retina remains detached, the less likely it is that your vision will fully recover.

The greatest risk of permanent vision loss is if your macula becomes detached. This is the part of your retina in charge of the central part of your vision.

Various techniques are available. Ask your doctor about the risks and benefits of the different treatment options. The type of surgery your eye doctor recommends will depend on several factors, including the severity of the retinal detachment. And, some patients may even need more than one type of surgery at once.

Retinal detachment surgery may involve:

  • Removing and replacing the clear jelly inside your eye (pars plana vitrectomy).
  • Injecting a gas bubble into your eye, pushing the retina against the back of your eye (pneumatic retinopexy).
  • Attaching a flexible band around your eye to bring the wall of your eye and retina closer together (scleral buckling).

Surgery is usually done under local anesthetic, so you’re awake, but your eye is completely numbed. During the procedure, you may experience pressure sensations or see shadows and bright lights inside the eye. This is normal as the retina is still functioning. Also, you may experience slight discomfort but no pain.

You could receive additional IV sedation to increase comfort, or very rarely, general anesthesia if necessary. Also, you do not usually need to stay in the hospital overnight.

WHAT HAPPENS DURING PARS PLANA VITRECTOMY?

Pars plana vitrectomy involves draining and replacing the jelly fluid within the eye. It provides better access to the retina, allowing to remove scar tissue or use focal laser surgery to fix retinal detachments or macular holes.

Indeed, most vitrectomy surgeries are ideal for resolving abnormal pulling (traction) by the vitreous humor on the retina.

During a vitrectomy, the surgeon uses an eyelid speculum to keep the affected eye open. Then, he makes three microscopic openings in the pars plana, the “safe zone” in the white of the eye (sclera). Hence, this procedure is called a posterior or pars plana vitrectomy.

The surgeon uses tiny instruments to cut away the vitreous gel from inside the eye. Then, the vitreous humor is gently removed along with any tissue tugging on the retina, and it is replaced by a salty fluid (saline solution).

Also, your doctor can use other vitreous substitutes, such as a gas bubble or silicone oil, injected into the vitreous space to help flatten and reposition the retina. They act as an internal splint and support the retina as it heals.

The choice will depend on how the retina behaves during the procedure. Eventually, the oil, gas, or liquid will be absorbed. If silicone oil is used, though, it will be surgically removed months later.

Along with the vitrectomy, the doctor will use a laser (inside the eye) or cryotherapy (from outside the eye) to seal the retinal holes. Tiny dissolvable stitches may be used to close the incisions, although no sutures are required in many cases.

Many vitrectomy surgeries can now be performed with minimal sutureless (no-stitch), self-sealing incisions, providing a faster visual recovery.

WHAT IS SCLERAL BUCKLING?

Sclerar bluckling involves indenting the external surface of your eye. The surgeon will suture a thin, flexible band of silicone material to the sclera of your eye. It is placed under the eye muscles in the area of the retinal holes. So, the splint will not be noticeable to the naked eye.

The procedure tries to relieve some of the force caused by the vitreous humor pulling on the retina. Essentially, the band pushes gently on the sides of your eye and moves them inward toward the retina, helping it to reattach.

If you have several tears or an extensive detachment, your surgeon may place a scleral buckle that encircles your entire eye, just like a belt. The buckle is permanent and positioned so that it doesn’t block your vision. In some cases, pars plana vitrectomy may be combined with a scleral buckling procedure.

WHAT IS PNEUMATIC RETINOPEXY?

With this technique, the surgeon injects a gas bubble into the center part of the eye (the vitreous cavity). When positioned properly, the bubble pushes the detached area of the retina against the posterior wall of the eye, stopping the fluid from flowing right to the space behind the retina.

The fluid previously collected under the retina is reabsorbed in time, and the retina can later adhere to the posterior wall of your eye. The bubble will push your retina back to its original position so that your doctor can use a laser or cryotherapy to repair any holes or tears.

You will have to hold your head in a particular position for several days to keep the bubble in place, though. You’ll see the air bubble in your side (peripheral) vision after the surgery. The bubble will reabsorb on its own over time.

HOW IS VITRECTOMY AFTERCARE?

Right after surgery, your eye may be red and sored– take paracetamol if you need to. You will have to use eye drops for up to 6 weeks until the eye heals. The drops help to prevent infection and reduce inflammation.

Avoid intense exercise and heavy lifting while your eye heals. Also, you should avoid getting shampoo or soap into your eye for four weeks. And swimming is out of the question for at least 12 weeks.

When a gas bubble or silicone oil is placed in your eye, you may need to avoid flying for up to eight weeks.

Also, you will be asked to keep your head and body in a specific position (most commonly face-down), depending on where the holes are placed. This is called ‘posturing’ and ensures that the gas or oil gives maximum support to the retinal holes. You may need to do this for up to 10 days after your surgery.

HOW LONG IS THE RECOVERY FROM RETINAL DETACHMENT REPAIR?

Following surgery, the vision recovery can take several months. You may have blurred vision for a few days or even weeks after your surgery. It can take between six to eight weeks before you can get an idea about how well you’ll see again.

If you have a gas bubble in the eye, the vision will be blurred until the bubble is absorbed. Conversely, if silicone oil is used, then your vision will remain blurred until it is corrected using regular/contact lenses or the oil is removed.

If the retinal detachment is left untreated for a long time and the vision is poor, to begin with, then the sight loss is often permanent.

IS THERE ANY RISK IN RETINAL DETACHMENT SURGERY?

Risks from surgery include bleeding inside the eye, infection, or developing cataracts. Also, if the initial surgery is not successful, it will be necessary to undergo further operations.

Indeed, postoperative scar tissue can be harmful and cause contraction of the retina. This is known as Proliferative Vitreoretinopathy (PVR), requiring further surgery and sometimes a poorer outcome.

Also, there is the possibility of developing a late corneal scar (corneal haze). This can happen in patients who undergo vitrectomy for retinal detachment and who had been subjected to corneal transplant surgery years earlier.

BEST RETINA SPECIALISTS IN SPAIN

Doctor Mª José Capella Elizalde

Doctor Mª José Capella Elizalde

Graduated in Medicine (Universidad Autónoma de Barcelona, 2005). Specialization in Ophthalmology at the Barraquer Ophthalmology Centre (2006-2010). Training in the subspecialty of Uveitis and Ocular Inflammation in USA centers such as the Massachusetts Eye Research and Surgery Institution and the Bascom Palmer Eye Institute (2011). Member of the Department of Vitreous-Retina and Uveitis and Ocular Inflammation Unit at the Barraquer Ophthalmology Centre. Member of the faculty of the Graduate Program of the Universidad Autónoma de Barcelona, given by the Institut Universitari Barraquer (Master Program and Intensive Courses).
Languages: Spanish, Catalan, English, French
Association number: 40.718

Doctor Javier Elizalde

Doctor Javier Elizalde

Bachelor in Medicine and Surgery (Universidad Autónoma de Barcelona, 1990). Doctor Cum Laude in Medicine and Surgery (UAB, 2003) with National Prize Thesis. Training of specialist in ophthalmology in the MIR Barraquer Ophthalmology Centre (1991-1994). Chief of residents in 1994. Training in USA in pathology and surgery of the vitreous and retina at the Bascom Palmer Eye Institute (Miami, 1995-1998) with Dr. Donald Gass, in Columbia University (New York) with Dr. Stanley Chang, at the Vitreous Retina Macula Consultants (New York) with Dr. Lawrence Yannuzzi and in Memphis (Tennessee) with Dr. Steve Charles. Complementary Training in ocular oncology at the Wills Eye Hospital (Philadelphia) with the Drs. Jerry and Carol Shields (1999). Deputy Coordinator of the Vitreous-Retina Department. Coordinator of the Ocular Oncology Unit. Vice-president of the Academic Board of the Barraquer Institute.
Languages: Spanish, Catalan, English, French, Italian
Association number: 27.498

Doctor Sònia Viver

Doctor Sònia Viver

Bachelor of Medicine and Surgery (2001) and specialist in Ophthalmology (2006). She works at the Vitreous-Retina Department of the Barraquer Ophthalmology Centre, highlighting her work in the field of diagnosis, treatment and monitoring of Age-Related Macular Degeneration. Member of the teaching staff of the Master, Diploma courses and other Postgraduate courses organized by the Institut Universitari Barraquer (UAB).
Languages: Spanish, Catalan, English

External links – Bibliography

Stickler syndrome. Epidemiology of retinal detachment.Vilaplana F, Muiños SJ, Nadal J, Elizalde J, Mojal S.

Vitrectomy without face-down posturing for idiopathic macular holes. Nadal J, Delas B, Piñero A.

Vitrectomy With Intrasurgical Control of Ocular Hypotony as a Treatment for Central Retina Artery Occlusion. Nadal J, Ding Wu A, Canut M.

Long-term visual outcomes and rehabilitation in Usher syndrome type II after retinal implant Argus II. Nadal J, Iglesias M.

Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes. Nadal J, Carreras E, Canut MI, Barraquer RI.

DO YOU WANT MORE INFORMATION ABOUT SURGERY FOR RETINAL DETACHMENT?

You can also contact us on WhatsApp or Viber at +34 657 460 421.

If you want a quote, please send a recent medical report.

    I have read and accept the terms and conditions of use *

    Terms and Conditions of Use Medical Solutions Barcelona

    Click here if you want more information about Barraquer Eye Hospital (Barcelona, Spain).

    Barraquer Ophthalmology Center Barcelona Spain Barraquer eye hospital Barcelona Spain

    Barraquer Eye Hospital

    Carrer de Muntaner, 314, 08021 Barcelona (Spain)

    Nearest Metro Stations:: Muntaner/ Gràcia