There are three ways of treating a retinal detachment. The one that would be recommended by your retinal surgeon would depend upon the extent of the retinal detachment, the location of the retinal tear/s, the evidence of any scar tissue formation, and the presence of prior cataract surgery.

The first method, which can be performed in the office setting is call a “pneumatic retinopexy “. It generally, involves two steps, the first is the injection of a small long-acting gas bubble into the eye, and positioning the patient is such a manner that the gas bubble covers the retinal tear/s. This prevents further migration of fluid into the subretinal space, allowing the normal function of the eye to pump out the fluid which has already accumulated under the retina. Once all the fluid under the retina has been removed and the retina around the retinal tear/s is flat, then the second step would be either laser and/or freezing (cryo-therapy) is performed around the tear, creating a low-grade inflammatory reaction which then results in an adherence of the retina to the wall of the eye. Retinal detachments treated in this manner are usually associated with few and small retinal tears with a detachment located above a horizontal line across the center of the eye.

As stated, after the gas bubble is injected into the eye, the patient has to be positioned in such a way as to cover the tear. This, in some cases, will require the patient to lie on their side for several days. This is often considered a hardship, but the procedure takes a much shorter time, as is the recuperative period, and the patient can usually return to normal activity in approximately 3 weeks.

The second method is called a “sclera buckle “. This procedure requires an admission into either the hospital or a surgical outpatient facility and is performed in an operating room, either under local or general anesthesia. It requires placing a solid silicone band or a silicone sponge under the tear/s and detached retina, draining the fluid from under the retina by cutting through the wall of the eye, thus allowing the retina to settle on the wall of the eye (flattening), and either freezing or lasering around the retinal tear/s to create an adhesion between the retina and the wall of the eye. The silicone remains in place throughout the patient’s lifetime unless a complication occurs with regards to the silicone band or sponge. The recuperative period can last up to 6 weeks and requires more frequent follow-up visits.

The third method of treating a retinal detachment, is to perform a “vitrectomy “, which is the removal of most of the gelatinous material (vitreous) within the eye. Once this is completed, the retinal tears are marked from the inside of the eye with diathermy, the fluid under the retina is drained from within, a large gas bubble is placed in the eye to hold the retina flat against the wall of the eye, the tear/s are treated with either freezing or laser, and the patient is positioned appropriately for the gas to cover the retinal tear/s. Occasionally, this method also involves the placement of a scleral buckle, if it is determined that the gas bubble cannot flatten the retina against the wall of the eye due to the location of the retinal tear/s, and/or there is scar tissue preventing the retina from flattening. This method is also performed in an operating room, under local or general anesthesia, and takes about the same amount of time for recovery and the same number follow-up visits as a sclera buckle. This procedure is more complicated than a sclera buckle, but its greatest advantage is that there is improved visualization of the retina during surgery. Tears, which could not be located prior to surgery, are identified, early scar tissue formation can be removed, and often, a sclera buckle is unnecessary. All complicated retinal detachments, especially those with traction, are treated with vitrectomy.