Treatment Options

Diagnosis begins with an eye examination for retinal tears and detachment. Several treatment options are available.

If the retina is torn but not fully detached, prompt treatment may prevent further detachment. But if the retina is completely detached, surgery is necessary. This can reattach the retina by sealing the tear to prevent the retina from pulling away from the back of the eye again. Depending upon how severe the detachment is, your eye surgeon may choose from these possible procedures:

Laser photocoagulation. If there is only a small amount of fluid around the tear, or a localized detachment, laser treatment may be recommended. The laser seals around the affected area to wall it off and prevent it from spreading.

Cryopexy. This freezing technique uses a very cold metallic probe, briefly touched to the outside of the affected area to "freeze" the back wall of the eye behind a retinal tear. Like ophthalmologic laser surgery. This stimulates scar formation that seals down the edges. Freezing may also be done on an outpatient basis – but it does require a local anesthetic to numb the eye.

Pneumatic retinopexy. In this procedure a gas bubble is injected into the vitreous cavity. It floats to reattach the retina. Laser or freezing treatment is preferred to seal the leak. For this procedure to be done there must be only one leak in the upper half of the eye.

Surgical repair. In the most severe cases – when fluid collected under the retina has completely separated it from the back of the eye – a more complex surgical procedure is required for reattachment. During the operation, the fluid collected behind the retina may be drained. This allows the retina to settle back into its original position on the eye wall. If necessary, a scleral buckle or silicone “belt” or pressure pad is used to gently push the back wall of the eye against the retina. Then a laser, freeze probe or an electric current applied through a needle (diathermy) seals the retinal tear. More severe detachments may require a vitrectomy. In this major eye operation, the surgeon uses delicate instruments - under the guidance of the operating microscope – to remove the vitreous gel away from the retina. This allows the surgeon to complete the reattachment. Eventually the body replaces the removed vitreous fluid.

Scleral Buckle. In this procedure a silicone belt is placed around the outside of the eye. The belt indents the wall of the eye to gently push the back wall of the eye against the retina. Fluid can be drained from beneath the retina, and freezing treatment applied to seal the leak.

Vitrectomy. With this operation, tiny holes are made in the wall of the eye to allow access to the center. The vitreous gel is removed from the eye. The retina is flattened under a bubble of air. Laser treatment is applied to seal around the leaks.

Outcomes.
More than 90 percent of all retinal detachments can now be reattached (although more than one operation may be needed). If successful, the reattachment prevents blindness and the eye will retain some sight. It takes several months for the eye to seal and reach its final vision. This final vision may vary significantly from one eye to the other.