Retina surgery

I have been advised retina surgery. Why is it done?

The retina is a thin delicate tissue within your eye. It is responsible for receiving light signals and sending them to the brain. The retina can be considered an extension of the brain itself as they develop from similar tissues. Surgery for the retina is called "Vitreoretinal surgery" and is performed for certain specific eye conditions.

• Bleeding within the eye: This can be caused by diabetic retinopathy, vein occlusions, retinal holes or eye injuries.

• Retinal detachment: Separation of the retina from its base is called retinal detachment. It is caused by weak areas in retina (holes/tears), diabetes or eye injury.

• Complex cataracts: Occasionally, complex cataracts have to be handled by a retina surgeon.

• Dislocated lens: Lenses placed within the eye after cataract surgery can change its position due to inadequate support for the lens. Retina surgery may be required to remove such a displaced lens and/or replace it.

How is retina surgery done?

The best approach for your retinal condition will be suggested by your eye doctor after thorough examination. Retina surgery is done after giving an injection near your eye to make it numb. In general, retinal surgery is done by the following methods:

Pars plana vitrectomy: The vitreous gel within the eye is removed through micro incisions in the white part of your eye. Removal of this gel helps to reduce the pull on the retina. Blood within the eye, if any, is also removed in this technique. A displaced artificial lens can also be removed. Retinal holes are sealed using laser treatment and retina may be supported using oil or gas. The choice depends on many factors that your eye surgeon will consider before making a final decision in the operation theatre. In case oil is used a second surgery is needed to remove oil. Use of gas avoids a second surgery.

Scleral buckle and vitrectomy: A special designed silicone band is sewn to outer wall of the eye (sclera) for some conditions. The vitreous gel within the eye may then be removed through small openings to reduce the pull on the retina. The breaks are sealed using laser treatment and retina will be supported using oil or gas. In case oil is used a second procedure is needed to remove oil.

I have to undergo retina surgery. What can be expected after the surgery?

After retina surgery some discomfort, redness, irritation and watering is expected. These are treated with eye drops. In order to help your retina attach well, your eye doctor may suggest certain positions that you have to maintain for a few weeks.

Even after retina is attached the visual improvement depends on the inherent strength of your of retina. Successful surgery and retinal reattachment is essential for, but does not guarantee, complete vision recovery. Visual improvement is usually slow and occurs over a period of one to two months. If there is detachment again, it signifies that the retinal strength is poor and more than one surgery may be required to attach the retina.

I have retinal detachment. However, I cannot undergo surgery immediately due to prior commitments. Can I postpone my retina surgery?

When the retina is detached, early surgery is preferable. The retina can be compared to a tree and the detached retina is similar to an uprooted tree. The longer the tree is uprooted, the more it is deprived of its nutrients. The tree continuously loses its strength. Replacing the tree early helps it to gain strength better. The longer the tree remains out of position, the more life it loses. Therefore chances of the tree gaining strength and staying rooted when replaced is reduced with time. If the tree has been uprooted for a very long time, the tree would have lost its vitality and is likely to fall down again. The same holds true for a retina that is detached. Early surgery is better.

If there is no retinal detachment or eye injury and there is only minimal bleeding, your doctor may consider delaying eye surgery for some time if there are other factors that require immediate attention. The best course of action in a particular situation is decided by having a detailed discussion with your retina doctor who has examined your eye about the condition of the retina and impact of delaying surgery.

Will my eye become perfect after retina surgery and will I regain full vision?

In eyes with retinal detachment, surgery is successful in repositioning the retina in 8-9 patients out of 10 patients. In 1-2 patients retina may not attach due to long duration of detachment, permanent changes in the retina or due to its intrinsic weakness. In these eyes, occasionally, a second surgery may be tried. Avoiding delay is very important in eyes with detached retina, especially if operating for a second time.

In eyes that have been filled with oil, it is removed after few months. At the time of oil removal 9 out of 10 patients do not have any problem. Rarely, the retina re-detaches and oil has to be put in again.

Repositioning the retina to its normal position is different from the retina achieving its full function. If one is diagnosed to have a retinal detachment, two points will influence the decision for surgery:

• There is very little scope of improving vision if the retina remains detached.

• Once reattached, the chance of vision improving is definitely present although it's extent cannot be predicted.

Vision improvement and adaptation happens over a few months. Some patients report persistently dull vision or glare even after many months denoting intrinsically poor retinal function.

Surgical procedure is the standard of treatment for the repair of detachment or for removal of blood in the eye. Retinal detachment surgery is aimed at improving the lost vision or maintaining the existing vision. Over the years thousands of patients have recovered their useful vision. After surgery, it is crucial to visit your eye doctor as per schedule and follow instructions meticulously for optimal outcomes.