When the retina pulls away from the back of the eye, this is retinal detachment, an emergency situation requiring surgery to save the patient’s vision. At Wilkinson Eye Center, we are fortunate to have Dr. Cagri Besirli perform these surgeries. He is our retina specialist at Wilkinson. Dr. Besirli is a board-certified ophthalmologist and has completed fellowships specializing in disease and surgery of the retina and vitreous.
What is retinal detachment?
There are three different types of retinal detachment. Each requires surgery to save the patient’s vision.
- Rhegmatogenous — This is the most common form of retinal detachment. They are caused by a hole or tear in the retina that allows fluid to pass through and collect underneath the retina, pulling the retina away from the underlying tissues.
Rhegmatogenous detachment is usually caused by normal aging. As we age, the gel-like material that fills the inside of the eye, the vitreous, can change in consistency and shrink or become more liquid. This separation usually happens without incident, but one complication is a tear. As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. If not addressed, the liquid vitreous can pass through the tear into the space behind the retina, causing the retina to detach.
- Tractional — In people with poorly controlled diabetes and other conditions, scar tissue can grow on the surface of the retina. This scar tissue can cause the retina to pull away from the back of the eye.
- Exudative — In this type of detachment, fluid accumulates beneath the retina, but there aren’t any holes or tears in the retina. Exudative detachment can be caused by age-related macular degeneration, injury to the eye, tumors, or inflammatory disorders.
What is retinal detachment surgery?
If the retina has a tear or hole but has not detached, Dr. Besirli may perform two procedures: photocoagulation or cryopexy. Photocoagulation uses a laser beam directed into the eye through the pupil. The laser energy burns around the retinal tear, creating scarring that attaches the retina to the underlying tissue. Cryopexy uses a freezing probe applied to the outer surface of the eye directly over the tear. The freezing creates scar tissue that helps secure the retina to the eyewall.
If you have a detached retina, you’ll need surgery with Dr. Besirli soon after your diagnosis. Here are three methods he may employ:
- Pneumatic retinopexy — In this surgery, Dr. Besirli injects a bubble of air or gas into the center of your eye, the vitreous cavity. The bubble then pushes the area of the retina containing the hole or holes back against the outer wall of the eye. This stops the flow of fluid into space behind the retina. Cryopexy may then be used to repair a break in the retina. Fluid under the retina is absorbed and the retina can then adhere to the wall as it formerly did. Patients usually need to hold their head in a certain position to keep the gas bubble in the proper position; this may be required for a period of several days.
- Scleral buckling — In this method, Dr. Besirli sutures a piece of silicone material to the white of your eye (the sclera) over the affected area. This procedure indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina. If you have several holes or tears, Dr. Besirli may place silicone around the entire eye, similar to a belt. This doesn’t affect vision and is usually placed permanently.
- Vitrectomy — In a vitrectomy, Dr. Besirli removes the vitreous along with any tissue that is tugging on the retina. Air, gas, or silicone oil is then injected into the vitreous space to help flatten the retina back against the wall. Eventually, the air, gas, or liquid will be absorbed, and the vitreous space will refill with body fluid.
How long is recovery after retinal detachment surgery?
Your recovery depends upon the method of surgery used. Each of the three procedures for a detached retina has different timelines, but the overall range for recovery is from two to six weeks.
- For pneumatic retinopexy, the recovery time is approximately three weeks. The most difficult part of this recovery is the need to maintain a specific head position for several days to keep the bubble in place long enough to repair the detachment.
- For scleral buckling, it is approximately two to four weeks. You’ll need antibiotic eyedrops to reduce the risk of infection, and you’ll likely wear an eye patch for a short period of time.
- For vitrectomy, recovery time is approximately four to six weeks. These procedures have the least involved recovery from a standpoint of what you need to do.
During your consultation, we will discuss your recovery in detail.
How long before I can return to normal activities after retinal detachment surgery?
Expect at least 4 to 6 weeks for most normal activities, although there can be wide variation with the patient. The key is to avoid increasing blood pressure to the face and eyes through strenuous exercise or activity or heavy lifting. Dr. Besirli will clear you for activities as he follows your recovery.
When is retinal detachment surgery needed?
If you have a detached retina, you’ll likely need surgery right away to raise the odds of saving your sight in that eye. This isn’t usually an optional procedure, as delaying any decision will likely lead to permanent damage to your vision.
If you only have a retinal hole or tear, but your retina has not detached, you may avoid surgery with the two methods discussed above, photocoagulation or cryopexy.
What are the risks involved with retinal detachment surgery?
These are surgical procedures, so there are some of the risks involved with any surgery, such as excessive bleeding or infection. Specific to retinal detachment surgery, these are the risks:
- Your vision may not be fully returned.
- The detached retina may not properly adhere, requiring further surgery.
- You may have an increase in intraocular pressure inside your eye, which can eventually damage the optical nerve.
Schedule Your Consultation Today
If you’re interested in learning more about retinal detachment surgery please contact us for a consultation at (248) 334-4931 or fill out our contact us form. We will discuss your needs and concerns, and determine your best course of action.