If you have a retinal tear, you are at an increased risk of developing a retinal detachment. For this reason, your NYU Langone ophthalmologist may perform one of two noninvasive procedures to repair the tear and seal the retina to the back of the eye.
The vast majority of retinal tears are treated with laser photocoagulation. Ophthalmologists occasionally perform cryotherapy if the location of the tear makes it difficult to perform laser photocoagulation.
Laser photocoagulation and cryotherapy can also be used to treat a retinal detachment and prevent it from becoming bigger.
Surgery is an option if a retinal detachment is big enough that it can’t be treated with laser photocoagulation and cryotherapy alone. Laser photocoagulation and cryotherapy may also be used in conjunction with surgery for complete treatment.
During photocoagulation, your eye surgeon numbs your eye with anesthetic eyedrops. The laser is then focused over the retinal tear or small detachment.
The laser emits a beam of light that travels through the eye and burns the area around the retinal tear or detachment to create a scar. This scar tissue helps seal the tear or reattach a detached portion of retina to underlying tissue. With retinal tears, the procedure prevents fluid from traveling underneath the retina, where it can cause detachment.
After this relatively painless procedure, your surgeon may administer a topical steroid to prevent inflammation. He or she may recommend bed rest for the first few days and suggest that you refrain from strenuous activities to allow the scars to form and your eye to heal.
Cryotherapy uses cold, or freezing therapy, to create a scar. After injecting an anesthetic around the eye, the surgeon places a freezing probe over the tear or small area of retinal detachment.
Each time an area is frozen, scar tissue forms. This scar tissue seals the tear or helps the retina reattach to the underlying tissues and keeps it in the correct place. Your eye surgeon may need to freeze several areas before the tear is sealed or the retina is reattached. You may feel a temporary cold sensation each time the probe is used.
After the procedure, your surgeon may put a topical steroid in your eye to prevent inflammation. As with laser photocoagulation, your doctor may recommend that you rest after the procedure so the scars can form and your eye can heal.
NYU Langone offers three surgical outpatient procedures to treat retinal detachment. Doctors determine the type of surgery needed based on several factors, including the location and size of the detachment and whether the person has had cataract surgery.
Scleral buckle is a common surgery used to treat retinal detachment. Doctors perform this outpatient procedure in the hospital using either local anesthesia with intravenous sedation or general anesthesia. Your doctor discusses anesthesia options with you before surgery.
For this procedure, the doctor locates the retinal tear that has caused a detachment and treats it with laser photocoagulation or cryotherapy. The procedure causes scar tissue to form a seal between the retina and the layers underneath.
Your surgeon then takes a small silicone band and places it on the outside of the sclera, or the white of the eye. Your surgeon sews it to the eye to keep it in place. This material buckles—pushes in—the sclera towards the middle of the eye, enabling the retina to settle against the back of the eye. The buckle stays in your eye permanently.
The scleral buckle relieves the retinal pull causing the detachment. A special intraocular gas may be injected into the eye, creating a bubble that expands and pushes the retina against the back of the eye. Surgery usually lasts two hours.
During a vitrectomy, your doctor makes an incision in the sclera of the eye and inserts an instrument to remove the vitreous gel. After the vitreous is removed, your doctor may treat the retina with photocoagulation or cryotherapy to seal the tear. The surgeon then injects intraocular gas to replace the vitreous gel and to gently push the retina against the back of the eye.
As you heal, the gas is spontaneously absorbed and disappears within two to six weeks. Your eye produces fluid that eventually replaces the gas and fills the eye. Surgery typically lasts about two hours.
For certain locations of retinal detachment, our ophthalmologists may perform a pneumatic retinopexy. During this procedure, your doctor places numbing drops in your eye, then inserts a small needle and removes a small amount of fluid to soften the eye.
Your doctor then injects a small amount of intraocular gas into the vitreous. The gas lasts for several days and gently pushes the retina against the back of the eye. The goal is to reattach the retina. Your doctor then performs laser photocoagulation or cryotherapy to seal the retinal tear. This procedure takes about one hour.
After surgery, it may take several weeks or months to regain full vision in the affected eye. Although your vision may not return completely to its previous state, the goal of surgery is to restore usable vision. You can usually resume everyday activities within a few weeks of surgery. Doctors discourage you from heavy exercise, lifting, and bending for the first few weeks.
Retinal surgery has a high success rate, and for most people vision is preserved. However, in some people, there may be a recurrence of retinal detachment that may require two or more surgeries to treat.
Risks and complications of all retinal surgeries include bleeding and infection. Doctors prescribe topical steroids and antibiotics to be taken for several weeks after surgery. Some people become more prone to developing a cataract after retinal surgery because surgery can trigger changes in the lens of the eye.
For any procedures in which intraocular gas is used, your doctor recommends certain precautions during the two to six weeks when the gas is in your eye. You should not fly in an airplane or have nitrous oxide for anesthesia because the intraocular gas can expand, damaging the eye.
Your doctor may also ask you to keep your head in a certain position as much as possible; head positioning allows the gas bubble to push the retina back into place. Your doctor can describe to you which positions are most conducive to your recovery, and which activities are safe and which ones to avoid.