Retinal detachment / surgical retina

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The retina is the light-sensitive tissue layer at the back of the eye, which transmits the messages to the light rays along the optic nerve to the brain where understanding of what is seen takes place. Light rays enter the eye through the transparent (clear) cornea then pass through the pupil in the centre of the iris (coloured part of the eye). Light must pass through the lens and vitreous (a jelly-like substance) before reaching the retina.

When a retinal detachment develops, a separation occurs between the retina and the underlying inner wall of the eye. This is similar to wallpaper peeling off a wall. The part that is detached (peeled off) will not work properly. The picture that the brain receives becomes patchy or may be split completely. Without treatment, a detached retina usually leads to blindness in the affected eye.

Contact us via this site or on 01274 612 566 for more information about detached retinas and the surgery necessary to repair them.

Read more about:

• Retinal detachment
• Macular hole surgery
• Macular pucker
• Vitrectomy for diabetes

Retinal detachment

What are the symptoms of retinal detachment?

When the retina is detached, people often describe seeing something black or a curtain in their vision. The sudden appearance of floaters and flashing lights requires a full eye examination to exclude the presence of retinal tears that can result in a retinal detachment if left untreated.

What are the causes of retinal detachment?

Nearly all retinal detachments develop because of a hole or tear in the retina. This usually occurs when the retina becomes 'thin', especially in short-sighted people or as the vitreous pulls on the retina. Other eye or health problems such as diabetes, cataract surgery and injuries such as a blow to the eye can occasionally be the cause of a retinal detachment.

What is the treatment for retinal detachment?

For a retinal hole or tear: To seal the retina around the tear and prevent the retina peeling off, you may be asked to have one of the following procedures:

• Laser - The retinal hole can be heat sealed (like spot welding) by directing a laser beam of light through the pupil of the eye. The scar produced seals the hole.
• Cryotherapy - Is freezing treatment applied by a pen-shaped probe to the outside of the eye. This freezes through to the retinal hole and, as with laser treatment, promotes scar tissue as a seal.

For a detached retina: The treatment involves surgery, applying 'splints' on the wall of the eye can seal retinal holes. These 'splints' are made of sponge or solid silicone material. They are placed under the skin of the eye and generally stay there permanently. They are not generally noticeable to other people.

• Vitrectomy - The retina can also be re-attached from the inside. This operation involves removing the vitreous (the jelly-like substance) and replacing it with a clear substance (gas or silicone oil). This closes off the break in the retina from the inside. The vitreous is cut and sucked out by using very fine instruments and an operating microscope. Tiny stitches are used to close the wound and do not need removal.

What are the benefits and risks of surgical retina correction?

The most obvious benefits are prevention of blindness and restoration of vision. You will have already lost some sight as a result of the detached retina. Successful retinal surgery will bring back some, but not all your sight.
Surgery for retinal detachment is however, not always successful. Every patient is different and retinal detachments vary in their complexity. It is important to appreciate that some patients require more than one operation. Your surgeon will advise you individually of the chances of success with the operation you are about to undergo.
You should also be aware that there is a small risk of complications, either during or after the operation. Your consultant will explain these.

Macular hole surgery

What is the macula?

The macula is the part of the retina that enables us to make out things clearly and see colours. Rays of light enter the eye and are focused on the macular area of the retina. A picture is then produced and sent along the optic nerve to the brain for interpretation. This is rather like the film in a camera being developed so that pictures can be produced.

What is a macular hole?

A macular hole is as it sounds, a hole in the macula. Usually the macula is attached to the inner surface of the eye. If there is a hole then fluid can get underneath it. When this happens the macula cannot compose a clear picture from the incoming rays and the vision becomes blurred and distorted.

Why do macular holes develop?

A macular hole is caused by an ageing process in the eye and is most commonly found in patients aged between 60-75 years. It is more common in females. The eye contains a clear jelly like substance called vitreous humour, which is attached, in parts to the retina. Because of the ageing, the vitreous humour shrinks and this can pull on thin areas of the retina in the macular area and cause a hole to appear.

What is the treatment for a macular hole?

An operation is required to remove the vitreous humour in order to reduce the pulling forces on the retina. A bubble of gas is injected into this space by the surgeon. This operation is called a vitrectomy. The surgery can be performed either under a local anaesthetic and involves the removal of vitreous gel and injection of a gas bubble. It is highly likely that you will develop a cataract (opacity or misting within the lens of the eye) after vitrectomy and gas. Therefore the removal of cataract and the insertion of a lens implant is often performed at the same time as the vitrectomy for the macular hole repair. This avoids needing subsequent cataract surgery within two years of a vitrectomy. We also want to assure you that the surgeon does not take your eye out of its socket to perform the operation.

What happens after a macular hole operation?

You will be discharged the same day. Following the operation you will be required to adopt a face down posture, which we call posturing. This position helps the bubble to float towards the macular hole and flatten it. Posturing is an extremely important part of your treatment. You will need to posture for about 10-14 days, or until your consultant advises you to stop. Further information on posturing is available and the staff will support you in achieving the best posturing position.

What will my vision be like after a macular hole operation?

Your vision will be blurred for 2-3 weeks following the operation. You may be able to see the bubble, which will appear as a wobbly black ring in your line of vision. The bubble will move as you move and gradually get smaller or break into smaller bubbles, which in turn will be totally absorbed. The natural fluids produced in the eye will eventually replace the bubble.

What are the benefits of macular hole surgery?

Vitrectomy surgery for macular hole often improves or stabilises vision and distortion. Vision after surgery depends on how damaged the vision was before surgery.

Macular Pucker

What is the macula?

The macula is a small area at the centre of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving.

What is macular pucker?

Macular pucker as the name suggest is wrinkling of the retina secondary to scar tissue formation on its surface. Inflammation or trauma can sometimes cause the scarring by a degenerative process in the vitreous (jelly of the eye), which is mostly age-related.

What are the symptoms of macular pucker?

Your vision will be blurred or distorted due to the presence of the scar tissue and the crinkling of the retina underneath.

What is the treatment for macular pucker?

An operation called vitrectomy is a type of eye surgery used to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye).
During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and removes the scar tissue from the retina through the tiny incisions.

During the procedure, the retina may be treated with a laser to fix a tear in the retina if present. A gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position.

After a vitrectomy you are expected to develop a cataract within six months to two years. A cataract is an opacity or misting within the lens of the eye and requires a subsequent operation called cataract extraction. However, cataract surgery can be performed at the same time as the vitrectomy. This will avoid having to return for a second operation in due course.

What will my vision be like after the macular pucker operation?

The vision will be very blurred for a few weeks after the operation and following the injection of a gas bubble you may see a wobbly black rim appear in your line of vision. The bubble will move as you move and may stay with you for two to four weeks. It will gradually get smaller, or may break up into small bubbles before disappearing. The eye will secrete clear fluid replacing that which was removed during the operation.

What are the benefits of macular pucker surgery?

Vitrectomy surgery for macular pucker often improves or stabilises vision and distortion. Vision after surgery depends on how damaged the detached retina was before surgery.

Vitrectomy for diabetes

Proliferative Diabetic Retinopathy (PDR) is a complication of diabetes caused by changes in the blood vessels of the eye.
In PDR, the retinal blood vessels are so badly damaged they close off. In response, the retina grows new, fragile blood vessels. Unfortunately theses new blood vessels are abnormal and grow on the surface of the retina, so they do not supply the retina with blood.

Occasionally these new blood vessels leak and cause a vitreous haemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause black floaters, while a large haemorrhage might block all vision, leaving only light or dark perception.

The new blood vessels also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula (small area at the centre of the retina that allows us to see fine detail) may detach from its normal position and cause visual loss.

What is the treatment?

Laser to the retina may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. The body will usually absorb blood from a vitreous haemorrhage, but that can take days, months or even years. If the vitreous haemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During the vitrectomy operation the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous haemorrhage and scar tissue from the retina if present. During the procedure, the retina may be treated with laser to reduce future bleeding or to fix a tear in the retina. A gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position.

What will my vision be like after the operation?

The vision will be blurred for a few weeks after the operation and following the injection of a gas bubble you may see a wobbly black rim appear in your line of vision. The bubble will move as you move and may stay with you for two to four weeks. It will gradually get smaller, or may break up into small bubbles before disappearing. The eye will secrete clear fluid replacing that which was removed during the operation.

After a vitrectomy you are expected to develop a cataract within six months to two years. A cataract is an opacity or misting within the lens of the eye and requires a subsequent operation called cataract extraction. However, often cataract surgery can be performed at the same time as the vitrectomy. This will avoid having to return for a second operation in due course.

What are the benefits of this eye surgery?

Vitrectomy surgery often improves or stabilises vision. Once blood-clouded vitreous is removed and replaced with a clear medium (often a salt water solution), light rays can once again focus on the retina. Vision after surgery depends on how damaged the retina was before surgery.