Treatment of retinal detachment

A retinal detachment is caused by the presence of one or more tears in the retina. This can occur due to changes in the vitreous. Over the years, the vitreous can shrink and the attachments in the retina can cause holes. When a hole has formed, fluid can get between the retina and the deeper layers of the eye. This is a retinal detachment. There are different ways to treat a retinal detachment.

Laser treatment

Holes or tears in the retina can lead to retinal detachment (ablatio retinae). This can be prevented by ‘welding’ the holes or cracks on their underlay with a laser. The scars that arise attach the retina to the underlying layers. The holes cannot then become larger and fluid cannot appear under the retina. If too much of the retina has become detached, it can no longer be repaired by laser treatment and surgery is necessary.

External surgery: Cerclage

When too much fluid has accumulated under the retina, laser treatment is no longer possible. The ophthalmologist may choose to place a band (cerclage) around the eye. Sometimes the eye is punctured to allow fluid to drain. The retinal hole is treated with, among other things, a laser to ensure good adhesion of the retina to the underlying layer. The hole is pressed shut with a silicone material and sometimes gas is left in the eye to keep the retina in place. Such an operation must be performed in a specialized ophthalmological (academic) center. The ophthalmologist can refer you there.

Internal surgery: Vitrectomy

A common reason to undergo a vitrectomy is a retinal detachment. During a vitrectomy, three small openings are made in the hard sclera next to the cornea. The vitreous is usually replaced by a special fluid, but sometimes by gas or oil. Gas and oil are used to support the retina for a while after surgery. The severity and nature of the eye abnormality determine the choice between liquid, gas and oil. The choice will be discussed with you before the operation. Sometimes the doctor will have to decide to deviate from this choice during the operation. The special fluid is quickly replaced by fluid that the eye makes itself. Gas is also replaced by its own fluid, but remains in the eye for longer. Oil does not disappear on its own, but must be removed with a second operation. As with any operation, bleeding or infection can occur after a vitrectomy. During bleeding, the image suddenly becomes blurred. Bleeding usually disappears on its own. An infection is rare, but can have serious consequences.

If you have not yet had cataract surgery, cataract surgery will be necessary some time after a vitrectomy. The period within which you will develop cataracts is highly variable (one month to several years, more likely at an older age). You will notice the development of cataracts by a slow decline in visual acuity. Sometimes the eye pressure is temporarily too high after the operation. The increase in eye pressure is usually treated with additional eye drops.

Sometimes a retinal detachment occurs after the operation to treat a retinal detachment. With a retinal detachment, part of the visual field disappears. The risk of retinal detachment is greatest in the first months after the vitrectomy. It is wise to check the field of vision occasionally yourself during this period. You can do this by moving your hand into the field of vision, while continuing to look straight ahead and keeping the eye that has not been operated on closed. You will usually continue to use eye drops for a few weeks after the operation. The eye will remain somewhat sensitive, red and swollen for a few weeks, during which time you will probably have difficulty tolerating bright light. After one to a few weeks you can resume all your activities.

We do not perform either external or internal surgery in our clinic. You will be referred for this.

Cataract after retinal surgery

If you have not yet had cataract surgery, cataract surgery will often be necessary some time after a vitrectomy. The period in which cataracts will develop in you is very variable (one month to several years, more likely at an older age). You will notice the development of cataracts by a slow decline in visual acuity. Sometimes the eye pressure is temporarily too high after the surgery. The increase in eye pressure is usually treated with extra eye drops. Sometimes it is decided to remove the lens during the retinal vitrectomy surgery and replace it with an artificial lens (cataract surgery).