Retinal detachments can cause significant vision loss; the symptoms of flashing lights, floaters and visual field changes (shadows in the visual field) warrant immediate medical attention to minimize the damage. According to the National Eye Institute, over 90 percent of retinal detachments can be successfully treated, though it sometimes requires two treatments. Of the available therapies, laser and freezing (cryopexy) procedures can be done in the office; however, most of the other surgeries require an operating suite.
Laser Photocoagulation
If there are retinal tears or holes, laser photocoagulation treatment can be very effective. The laser uses heat to weld the retina back into the appropriate place. This also prevents any further detachment by sealing the edges of the retina in place. Laser photocoagulation can be completed using either a topical numbing drop or a shot of anesthetic medication behind the eye in the physician's office.
Cryopexy
This procedure has a similar concept as laser photocoagulation in that cryopexy freezes the retina back into place as well. The physician uses a cryoprobe and places it against the outside of the eye over the area of the holes or tears, to freeze the retina. This procedure can be done in an office setting; however, an anesthetic shot is needed since numbing drops would not be sufficient to remove the pain during the procedure.
Injection of Air Bubble (Pneumatic Retinopexy)
In another office procedure, the eye doctor may inject a bubble of air into the vitreous to press the retina against the back of the eye. This procedure is often done in conjunction with laser photocoagulation or cryopexy. Because the gas is lighter in weight than the vitreous, the eye surgeon may ask the patient to lie or sit in a certain position to make sure the bubble is resting against the affected area of the retina while it heals. The gas bubble will eventually will be absorbed by the body so no removal procedure is needed.
Scleral Buckle
For a more significant detachment, some surgeons may use a scleral buckle, which is a thin plastic or synthetic band that wraps around the eye. The band compresses the walls of the eye to bring them into contact with the detached retina; this causes the retina to reattach. The placement of the band can increase the length of the eye. This change can alter the refractive error of the eye, usually making it more nearsighted (myopic). Scleral buckle surgery is performed in the operating room under general anesthesia.
Vitrectomy with Gas, Air or Oil Bubble
In some cases, the eye surgeon will remove the vitreous jelly from inside of the eye and replace it with either a gas, air or silicone oil bubble. The bubble serves to flatten the retina out as well. A vitrectomy may also be used with any of the other therapies to completely treat the retinal disease. If silicone oil is used, the patient may have to undergo a second surgery to remove the oil after the retinal has healed itself; the gas or air will be reabsorbed into the body.
