Treatments and drugs

By Mayo Clinic Staff

Surgery is almost always used to repair a retinal tear, hole or detachment. Your ophthalmologist can tell you about the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.

Retinal tears

When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest an outpatient procedure, which can usually prevent retinal detachment and preserve almost all of your vision.

  • Laser surgery (photocoagulation). The surgeon directs a laser beam at the retinal tear. The laser makes burns around the tear, creating scarring that usually "welds" the retina to underlying tissue.
  • Freezing. In this process, called cryopexy (KRY-o-pek-see), the surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect and freezes the area around the hole, resulting in a scar that helps secure the retina to the eye wall.

After your procedure, you likely will be advised to refrain from vigorous activity for the next two weeks or so to allow time for the bonds created by your procedure to strengthen.

Retinal detachment

If your retina has detached, doctors will also use surgical procedures to repair it. These procedures may be done along with photocoagulation or cryopexy. The specifics of your retinal detachment will determine which approach your surgeon recommends. Sometimes people need a second surgery for successful treatment.

  • Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy (RET-ih-no-pek-see), your doctor injects a bubble of air or gas into the vitreous. When the bubble is successfully placed to float against the retinal tear and the area surrounding the tear, it seals the tear. This stops further flow of fluid into the space behind the retina.

    Fluid that had collected under the retina is absorbed by itself, and the retina can then reattach itself to the back wall of your eye. You may need to hold your head in a certain position for up to several days to keep the bubble in place. The bubble eventually will also be reabsorbed on its own.

  • Indenting the surface of your eye. This procedure, called scleral (SKLEER-ul) buckling, involves the doctor sewing (suturing) a piece of silicone rubber or sponge to the white of your eye (sclera) over the affected area. The silicone material indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.

    If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that circles your entire eye like a belt. The buckle usually remains in place for the rest of your life.

  • Draining and replacing the fluid in the eye. In this procedure, called vitrectomy (vih-TREK-tuh-me), the doctor removes the vitreous along with any tissue that is tugging on the retina. Air, gas or liquids are then injected into the vitreous space to reattach the retina.

    Eventually the air, gas or liquid will be absorbed and the vitreous space will refill with body fluid. However, if the retinal detachment repair uses a silicone oil, the oil is often surgically removed months later.

    A vitrectomy is often combined with a scleral buckling procedure.

Surgery doesn't always work to reattach the retina. Also, a reattached retina doesn't guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery and, if it was, for how long. Your vision may take many months to improve after repair of a retinal detachment. Some people don't recover any lost vision.

July 08, 2014