Surgery for Retinal Detachment

Retinal detachment happens when your retina (a light-sensitive layer of tissue at the back of your
eye) is pulled away from its normal position. Retinal detachment is a medical emergency, and
early treatment is important to protect your vision.
Learn more about retinal detachment
If you have a retinal detachment, you may need surgery to reattach your retina to the back of
your eye within a few days. After surgery, you may need to stay in the hospital for a short time
and it might take a few weeks before your vision starts getting better.
There are 3 types of surgery that doctors can do to fix a detached retina:
 Pneumatic retinopexy (“noo-mat-ick RET-ih-no-pek-see”)
 Scleral buckle
 Vitrectomy
The type of surgery you need will depend on several things, including how much of your retina
is detached and where in your eye it detached. Your doctor will talk to you about what type they
recommend, and about the risks and benefits of surgery. Some people may need more than one
type of surgery at once.
During the surgery, your doctor may also use laser or freeze treatments to repair tears or holes in
your retina and help hold your retina in place after surgery.
Learn more about laser surgery and freeze treatment

What is pneumatic retinopexy?

In pneumatic retinopexy, your doctor will inject a small air bubble into your eye. The bubble will
push your retina back into place so your doctor can use a laser or freeze treatment to repair any
holes or tears. You can usually get this surgery in your doctor’s office.
When you get this surgery, your doctor will:
 Put numbing medicine in your eye
 Insert a tiny needle into your eye and remove a small amount of fluid
 Inject a small amount of air into your eye
 Use laser or freeze treatment to repair any holes or tears in your retina
You’ll be able to see the air bubble in your peripheral (side) vision after the surgery. The bubble
will disappear on its own over time.
After the surgery, you’ll need to:
 Hold your head in a certain position for several days to keep the air bubble in the right spot
 Avoid some activities — like flying in an airplane, intense exercise, and heavy lifting — while
your eye heals
 Have a follow-up visit with your doctor to make sure your eye is healing
Tell your doctor if you have any questions or concerns after surgery, including if your vision
seems worse or if you have a lot of pain or swelling.

What is scleral buckle surgery?

During scleral buckle surgery, your doctor will put a tiny, flexible band around the white part of your eye. This part of the eye is called the sclera.
The band pushes gently on the sides of your eye and moves them inward toward your retina,
which helps your retina reattach. The band will stay on your eye permanently after the surgery.
Your doctor may also use a laser or freeze treatment to repair any tears in your retina.
Usually, you’ll get anesthesia so you’ll be asleep during this surgery. You won’t feel anything or
remember the surgery. Most people can go home the same day, but you’ll need someone to drive you home. After the surgery, your eye may feel a little sore. You’ll need to:
 Wear a patch over your eye for about a day
 Avoid some activities — like heavy lifting or heavy exercise — while your eye heals
 Have a follow-up visit with your doctor to make sure your eye is healing
Tell your doctor if you have any questions or concerns after surgery, including if your vision
seems worse or if you have a lot of pain or swelling.
What is vitrectomy?
Vitrectomy is similar to pneumatic retinopexy, but it’s a longer surgery and usually happens in a
hospital instead of your doctor’s office.
Cornea Transplant Surgery:
The cornea is the clear layer on the front of your eye that
helps focus light so you can see clearly. If it gets damaged,
you might need to have it replaced.
The surgeon will remove all or part of your cornea and
replace it with a healthy layer of tissue. The new cornea
comes from people who chose to donate this tissue when
they died.
A cornea transplant, also called keratoplasty, can bring
back vision, lessen pain, and possible improve the
appearance of your cornea if it is white and scarred.
Who Needs One?
The light rays that pass through a damaged cornea can get
distorted and change your vision.
A corneal transplant corrects several eye problems,
including:
 Cornea scarring because of an injury or an infection
 Corneal ulcers or “sores” from an infection
 A medical condition that makes your cornea bulge out
(keratoconus)
 Thinning, clouding, or swelling of the cornea
 Inherited eye diseases, such as Fuchs’ dystrophy and
others
 Problems caused by an earlier eye operation
Full Thickness Corneal Transplant
If the doctor does a penetrating keratoplasty (PK), all the layers of your cornea get replaced. The surgeon sews the
new cornea onto your eye with stitches thinner than hair. You might need this procedure if you have a severe corneainjury or bad bulging and scarring. It has the longest healing time. Partial Thickness Corneal Transplant
During deep anterior lamellar keratoplasty (DALK), the surgeon injects air to lift off and separate the thin outside
and thick middle layers of your cornea, then removes and replaces only those.
People with keratoconus or a corneal scar that hasn’t affected the inner layers may have this done.
The healing time with this procedure is shorter than a full thickness transplant. Because your eye itself isn’t opened up, it’s unlikely the lens and iris could be damaged, and there’s less chance of an infection inside your eye. Endothelial Keratoplasty About half of the people who need cornea transplants each year have a problem with the
innermost layer of the cornea, the endothelium. Doctors often do this type of surgery to help Fuchs’ dystrophy and other medical conditions.
Descemet’s stripping endothelial keratoplasty (DSEK or DSAEK) is the most common type of endothelial keratoplasty. The surgeon removes the endothelium — a mere one cell thick — and the
Descemet membrane just above it. Then they replace them with a donated endothelium and Descemet membrane still attached to the stroma (the cornea’s thick middle layer) to help him handle the new tissue without damaging it. Another variation, Descemet’s membrane endothelial keratoplasty (DMEK), transplants just the endothelium and Descemet membrane — no supporting stroma. The donor tissue is very thin and
fragile, so it’s harder to work with, but healing from this procedure is usually quicker and often, the end result vision may be slightly better.
A third option for selected people with Fuch’s dystrophy is simple removal of the central part of
the inner membrane without a transplant, if the surrounding cornea seems healthy enough to
provide cells to fill in the removed area.
These surgeries are good options for people with cornea damage only in the inner layer because
recovery is easier.
What’s the Surgery Like?
Before your operation, your doctor will probably do an exam and some lab tests to check that
you’re in good general health. You may have to stop taking certain medicines, such as aspirin, a
couple of weeks before the procedure.
Usually, you’ll have to use antibiotic drops in your eye the day before your transplant to help prevent an infection.
Most of the time, these surgeries are done as outpatient procedures under local anesthesia. This
means you’ll be awake but woozy, the area is numb, and you’ll be able to go home the same day.
Your doctor will do the entire surgery while looking through a microscope. It typically takes 3 minutes to an hour. Recovery
Afterward, you’ll probably wear an eye patch for at least a day, maybe 4, until the top layer of
your cornea heals. Your eye will most likely be red and sensitive to light. It might hurt or feel
sore for a few days, but some people don’t feel any discomfort.
Your doctor will prescribe eye drops to bring down inflammation and lower the chances of infection.
They may prescribe other medicines to help with pain. They’ll want to check your eye the day after surgery,
several times during the following couple of weeks, and then a few more times during the first year.
For transplant procedures such as DSEK and DMEK that use a gas bubble inside the eye to help position the
transplanted tissue, the surgeon may ask you to lie flat sometimes during the day and sleep flat on your back at night for a few days.
You’ll have to protect your eye from injury after your
surgery. Follow your doctor’s instructions carefully.
Your cornea doesn’t get any blood, so it heals slowly. If
you needed stitches, your doctor will take them out at the
office a few months later.