Retinal Detachment Surgery

  • Reference Number: HEY-174/2018
  • Departments: Ophthalmology Department

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the health care team caring for you.

What is retinal detachment?

The retina is a thin layer of nerve cells and blood vessels that lines the inside of the eye. It is sensitive to light like the film in a camera and is essential for you to be able to see.

Retinal detachments occur when a hole or several holes have developed in the retina, fluid has passed through the holes causing the retina to peel away from the inside of the eye similar to a blister. The result of this process is the loss of whole or part of your vision. Without treatment this usually leads to permanent loss of vision in the affected eye.

A retinal detachment can occur at any time with no apparent cause. It is known that some people are at a greater risk of developing retinal detachments; for instance people who are short sighted, those who have had cataract surgery and those who have had a severe blow directly to the eye. Further information is also available in the booklet ‘Retinal Detachment’ published by the Royal National Institute for the Blind RNIB.

Do I need treatment?

Yes, as the most obvious benefit is the prevention of blindness and restoration of vision. You will have already lost some of your sight as a result of the retinal
detachment. Successful surgery will usually bring back some of your sight, however it will not usually completely restore your vision.

You need to be aware that surgery for retinal detachment is not always successful. Every patient is different and retinal detachments vary in their complexity. It is important that you realise that some patients need more than one operation to treat their retinal detachment. Your surgeon will advise you on the chances of success with the operation.

The operation is aimed at sealing the retinal holes and reattaching the retina to the inside of the eye. We normally carry out the operation under local anaesthetic. You will be awake for the whole operation. You will be aware of bright lights and you may experience some slight discomfort. You will have an injection of local anaesthetic into the tissues around the eye, which numbs your eye. You will need to keep your head still for the duration of the operation. In some circumstances you may need a general anaesthetic; in this case you will be asked not to eat or drink for several hours before the operation. The anesthetist will come and visit you on the ward before the operation takes place. You will be asleep for the operation, which takes approximately one hour.

Surgery for retinal detachment

There are two approaches to retinal detachment surgery, these are described below. Your surgeon will advise you which approach is best for your particular case before the operation. You will also be warned that the plan may change during the operation, depending on how the eye and retina behaves during the operation.

Internal approach

This approach is most commonly used. An operation called Vitrectomy is performed which is undertaken by making three tiny incisions approximately 1 mm long in the white of the eye so that tiny instruments can be used to cut away the vitreous gel from inside the eye. As this is happening, the vitreous is replaced by a salty fluid. After removal of the vitreous, the retina is repositioned using an internal splint. This is either a gas bubble or silicone oil, which supports the retina whilst healing takes place. This choice is made depending upon how the eye and retina behave during the procedure. It is a combination of a freezing treatment to the white of the eye and / or laser treatment to the retina, to help seal the retinal holes. Small stitches are used to seal incisions made in the white of the eye.

During the operation you may be aware of pressure sensations around the eye, or some shadows and lights inside the eye. This is quite normal as the retina is still functioning. The amount varies due to the intensity of the local anaesthetic. Following surgery you will need to use eye drops for up to 6 weeks whilst the eye heals. You will be advised on how and when to use the eye drops before leaving hospital. The drops are to prevent infection and to reduce inflammation around the eye.

When a gas bubble has been used to help the hole to heal, it is very important that you must not travel by aeroplane until the gas has been absorbed (this can be up to 8 weeks). Your doctor will be able to confirm this with you when you are seen in outpatients. If you need a general anaesthetic for another problem, it is essential that you inform the anesthetist that you have a gas inside the eye. In most cases, you may be asked to keep your head in a specific position to help the gas bubble do its job; this will be discussed with you before the operation and written instructions will be given to you before you go home. Sometimes a special type of oil (silicone oil) is used instead of gas. This is usually removed later at a second operation. Your doctor will give you full details, should this be necessary.

External approach

Retinal holes can be sealed and supported by applying a silicone splint to the outside wall of the eye. This is stitched in place to the white part of the eye and placed under the eye muscles in the area of the retinal holes. The thin conjunctival membrane that covers the eye also covers the splint. The splint stays on the eye permanently and is not visible to the naked eye. It is a combination of a freezing treatment to the white of the eye and laser treatment to the retina to help seal the retinal holes.

Can there be any complications or risks?

If the initial surgery is not successful, it will be necessary to undergo further operations. Occasionally, retinal holes can reopen or new ones develop and the retina may re-detach. When the retina has detached, the body tries to heal the damage itself. Instead of this healing being helpful, it can cause scar tissue inside the eye that causes contraction of the retina. This is referred to as Proliferative Vitreoretinopathy (PVR) and can involve more complex surgery and sometimes a poorer outcome.

This type of surgery has similar risks to other types of eye surgery such as:

  •  Infection in the eye, called endophthalmitis, which is very rare but can give rise to serious loss of sight.
  •  Bleeding inside the eye.
  •  Cataract – Almost all patients develop a cataract (cloudy lens) more rapidly following this type of surgery. This is because the internal fluid has been disturbed and also due to the presence of any gas in the eye. In some cases the cataract may be removed at the same time to enable a clearer view for the vitrectomy surgery to be performed. Cataracts can also be removed in a separate operation. Your surgeon will discuss the best option for your eye condition.
  •  High pressure inside the eye – you may need additional eye drops to control this for a period of time.
  •  Double vision.
  •  Inflammation inside the eye.
  •  Bruising to the eyelids and eye – this settles after a few weeks.
  •  Allergy to the medication used.

If you experience any of the following problems after you have gone home following your operation, you should contact the ward immediately.

  •  Excessive pain.
  •  Loss of vision.
  •  Increasing redness of the eye.
  • Dirty discharge from the eye.

How do I prepare for the operation?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

This is major eye surgery. It is normally carried out under local anaesthetic; in exceptional circumstances a General anaesthetic is offered.

Before the surgery you will be asked questions about your general health. Some blood tests and a heart recording (ECG – Electrocardiogram) are performed to ensure your general health is good enough to undergo the surgery. Measurements will be made of your eyes length and curvature; this is required for planning the local anaesthetic. We will need to know what tablets and medicines you are currently taking and also if you are sensitive to any substances. It may be useful to write these down to bring to your assessment. At this visit, you will be advised on what pre-operative preparations you need to make, such as altering medications.

What will happen?

Upon arrival

The operation is usually carried out as a day case and you will need to be at the Eye Hospital for 7.30am on the day of surgery. You can expect to be there for most of the day; you may also need to stay overnight. You need to report to the reception desk and you will then be directed to the Eye Ward.

In many cases the surgery is carried out on an emergency or urgent basis, including a weekend. You will be advised on what time you need to come into hospital.

The following morning, you will need to attend the ward for a quick eye check. For patients who are travelling long distances, it may be possible to stay overnight.

  • Due to space restrictions, if you want to bring anyone with you we request only one person accompanies you. They will be requested to come back to collect you later in the day.
  •  Please bring a clean dressing gown and pair of slippers with you, with overnight clothing and toiletries.
  •  If you use a hearing aid bring it with you.
  •  Take your usual medications unless you have been advised to stop them prior to surgery.
  •  Also bring any medications that you may need to take whilst you are in hospital, including inhalers, sprays.
  •  Do not wear any make up, nail varnish or jewellery other than a wedding ring, as you will need to remove it before your operation.
  •  It is advisable not to bring valuables or money to the hospital; the Trust will not accept responsibility for loss or theft.
  • Eat and drink normally before coming into hospital unless you have been advised not to do so.
  •  On arrival to the ward, a nurse will meet you and confirm the information that you gave at your pre-assessment visit.
  •  Eye drops to dilate the pupil of the eye you are having operated on are instilled. This is to enable the surgeon to see the retina and carry out the operation.
  • You will be asked to get changed into a hospital gown and your dressing gown and slippers.
  • Patients are offered drinks and light snacks free of charge.
  • Visitors are asked to use the dining facilities in the main hospital or Women and Children’s hospital. A drinks machine is available on the ground floor.
  •  During your stay, several checks are made to ensure the correct patient receives the correct procedure on the correct eye. These may seem tedious but are in the interests of your safety.

What happens afterwards?

Following the operation and after care

When gas bubble or silicone oil has been placed in your eye, you will be asked to keep your head and body in a specific position. This is called ‘posturing’ and is to ensure that the gas or oil gives maximum support to the retinal holes. This is a very important part of your treatment and your co-operation will give your retina the best chance for successful treatment. Depending on where the holes are positioned, you will be instructed on how to place your head and body in the most effective position. You are advised to adopt the required position for long periods of time, for example 50 minutes out of each hour for 10 – 14 days. You may also have to sleep in a particular position.

Important points to follow

  •  You will be told when you need to come for a check up, how to look after your eye and when to use the eye drops to help the eye to heal.
  • You will be advised on any posturing that needs to be carried out.
  • You do not need to keep the eye covered once the anaesthetic has worn off.
  • You should avoid heavy lifting and straining for the first week.
  •  You should avoid getting shampoo and soap into your eye for 4 weeks.
  • You should avoid swimming for 12 weeks.
  • You must not drive until you reach the minimum legal standard of vision.
  • You should not drive until the anaesthetic has completely worn off and there is no double vision.
  •  It is normal for the eye to appear red and feel gritty; this is due to the membrane covering the white of the eye being sutured after the operation and some of these effects may last up to 4 weeks. The stitches are dissolvable but take several weeks to completely dissolve.

Long term recovery

  • Following the surgery, the vision recovers over several months and is not instant. This is because the retina needs to recover.
  •  If you had a gas bubble in the eye, the vision is very blurred until the bubble is absorbed. If silicone oil was used, then the vision is blurred until it is corrected using lenses or the oil is removed.
  •  You may need a sight test to see if glasses will help you see better.
  • The final vision depends on the nature of the retinal detachment. If the vision was good immediately before surgery, it is likely to remain so after surgery. If the retinal detachment has been present for a long time and the vision has been poor for a long time, then the sight loss is often permanent.
  •  You may find that you cannot read using the affected eye. You may find that you cannot read number plates or recognise faces. The side vision is usually preserved. This side vision is very important for day-to-day activities such as going out or going up steps.

Follow up appointments

You will be reviewed in the Eye Clinic after 2 weeks and then at 8 weeks following surgery.

If for any reason you are unable to attend for your appointments or need further advice, please contact:

Eye Clinic on telephone (01482) 608788 (8.30 am – 5.00 pm) or Ward 35 (01482) 604346 open 24 hrs.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact Ward 35, Hull Royal Infirmary on (01482) 604346 (24 hours) or the Eye Clinic (01482) 608788 (Monday-Friday 8:30am – 5:00pm )

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.