Life After Retinal Detachment Surgery
The retina is a thin layer of cellular tissue at the back of the eye that receives light rays and converts them into electrical signals that travel to the brain via the optic nerve, generating the image you see. In certain situations, the retina can detach from the back of the eye and cause vision loss. Because retinal detachments are a medical/surgical emergency, the serious nature of this eye condition leaves many patients wondering what life looks like after surgery.
What Causes Retinal Detachment
Retinal detachment can occur for many reasons, including the following causes:
- Natural aging in relation to the vitreous (the gel-like substance within the eye)
- Diabetic retinopathy
- Eye trauma
- Myopia (nearsightedness)
- Specific inherited vitreoretinal conditions
In each case, the vitreous first begins to liquefy and separate from the retina. Sometimes, this does not produce symptoms. Other times, you may experience floaters, flashes of light, or a shadow in your vision when the vitreous pulls on the retina. However, in more severe instances, shifting of the vitreous can pull away with such force that it causes the retina to tear and become detached after the liquefied vitreous seeps into the retinal tear and separates the retina eye wall.
The retina has many layers, including various neurons, a layer of rods and cones that assist with color vision and peripheral vision, and a layer closer to the eye wall called the retinal pigment epithelium, which helps pump fluid. A retinal detachment separates these layers, making it difficult to transmit what you see.
Here are the three types of retinal detachments and their causes:
Rhegmatogenous retinal detachment: This type of detachment occurs when the retina has a small break or tear. It is the most common type of retinal detachment. Once a tear occurs, fluid can pool underneath the retina and cause it to detach from the back of the eye. Old age is a common cause of rhegmatogenous retinal detachment due to the fact that the vitreous can shrink or change texture and liquefy in older adults. This increases the likelihood that the vitreous will pull away from the retina causing a tear. It can also occur in people who experience thinning or weaker structural areas of the peripheral retina, called lattice degeneration. A rhegmatogenous retinal detachment can also occur in association with eye trauma, previous eye surgery, or nearsightedness.
Tractional retinal detachment: This type of detachment can occur when scar tissue forms on the retina and causes it to pull away from the back of the eye. Tractional retinal detachment is seen in people with advanced proliferative diabetic retinopathy, a condition that leads to scarring due to the accumulation of abnormal blood vessels. When scar tissue accumulates and contracts, it places enough traction on the retina to tear or detach it. Scar tissue may also develop following eye inflammation or from an eye injury.
Exudative retinal detachment: This type of detachment occurs when fluid accumulates behind the retina. The main difference between an exudative detachment and other types of detachment is there are no tears or holes in the retina. Instead, fluid becomes trapped at the back of the retina and pushes the retina away to cause detachment. The excess fluid is usually associated with leaks from abnormal blood vessels or swelling from inflammation, infection, or tumors.
What to Expect After Retinal Detachment Surgery
Recovery depends on which type of procedure your ophthalmologist performs to fix the detached retina. Procedure options include the following:
- Pneumatic retinopexy: This in-office procedure involves an injection of gas into the vitreous to create a bubble that pushes the retina back in place. Once repositioned, your ophthalmologist performs laser surgery or cryopexy (freezing therapy) to seal any tears to prevent the detachments from reoccurring.
- Scleral buckle: This surgery involves the placement of a silicon band around the sclera (the white part of the eyeball) to counteract the internal pulling forces of the vitreous. Your ophthalmologist may perform laser surgery or cryopexy to seal the existing retinal tear.
- Vitrectomy: This surgery involves a small incision to suction part of the vitreous to give your eye surgeon easier access to the retina. Then, depending on the cause of the detachment, repairs will be performed. Examples include laser surgery to repair the retina; placement of a bubble (air, gas, or oil) to reposition the retina; removing scar tissue from the retina; or removing foreign objects. The vitreous can then be replaced with either silicone oil or a gas bubble.
The days and weeks after any of these procedures are important for your recovery. Be sure to follow the directions from your ophthalmologist and nurses.
It can take several weeks (even months) to see vision improvement following surgery, making it difficult to see certain objects or read. You may also experience blurry vision, eye irritation, redness, swelling, double vision, or an increased sensitivity to light. These symptoms are usually temporary and should improve with time.
As with any surgery, there are complications that may occur. Examples include the formation of cataracts, glaucoma, recurrent retinal tears, eye bleeding, eye inflammation, or even re-detachments. Speak with your retina specialist if you have any specific concerns.
Pneumatic Retinopexy Recovery
Recovery for a pneumatic retinopexy requires strict adherence to head positioning as per your eye doctor’s orders to prevent the gas bubble from shifting or moving – the gas bubble needs to stay in the correct place for several weeks to ensure a successful surgery.
Typically, post-surgery restrictions include not lying on your back or flying in an airplay for several weeks. Altitude changes can have dangerous effects on your eye. The cabin pressure causes the bubble to expand, which can lead to increased intraocular pressure and even blindness.
You also need to keep your head in a downward facing position for most of the day – usually 50 minutes per hour for the first week. This helps keep the bubble pressed against the retinal tear and retina. Avoid performing household tasks that cause your head to move such as cleaning or lifting heavy objects. Although keeping your head in this position can be cumbersome – the tradeoff is you avoid major surgery.
Scleral Buckle Recovery
Although it is an in-office procedure, a full recovery for a scleral buckle usually takes two to four weeks. Pain can linger for several days after the procedure, but an over-the-counter pain reliever will help alleviate discomfort. You may experience redness and swelling for up to a month after a scleral buckle. Ask your eye doctor about applying an ice pack to your eye to reduce swelling. Prescription anti-inflammatory eye drops can also help treat irritation.
Following the procedure, you may leave with an eye patch to wear for several days to protect the eye. Prescription antibiotic drops will also help prevent an infection.
Immediately following surgery, your ophthalmologist will likely have you wear an eye patch to protect it for the first few days of your recovery. The eye itself may be swollen or tender for weeks.
You will be instructed to use eye drops daily for up to a month to prevent infection and protect the pupil.
Similar to a pneumatic retinopexy, you must follow strict instructions if you had a bubble placed during your vitrectomy. You will need to keep your head down or in a side-facing position (no lying on your back) so the bubble keeps the retina in place. Avoid flying as changes in pressure can impact the bubble and cause dangerous side effects.
How to Improve Vision After Retinal Detachment Surgery
While retinal detachment surgery has a greater than 90% success rate according to the National Eye Institute, it may still take weeks to months to see clearly.
Your visual acuity after surgery depends on the nature of the detachment. For example, patients have a positive prognosis if the macula (central area of vision) is not involved. A study published by the American Journal of Ophthalmology found 83% of patients had a visual acuity of 20/40 or better after retinal detachment surgery if the macula remains attached. Conversely, patients are at a high risk of legal blindness (less than 20/200) if the macula has been detached for an extended period of time. Furthermore, because a detachment affects rods and cones, you are much more likely to have a better prognosis the sooner you have surgery.