Dr Robert Bourke > My specialties > Retinal detachment

Retinal detachment

A retinal detachment is a progressive blinding condition, which if left untreated, leads to irreversible blindness and loss of the eye. A retinal detachment is a disorder in which the retina peels away from the underlying layer of support tissue, usually the result of a retinal break, hole or tear. As a result, fluid leaks underneath the retina, causing detachment. There are usually a number of warning symptoms – floaters or flashes of light, followed by a dark shadow at the side of the vision.

Today, the repair of retinal detachments has greatly improved and we can usually restore good vision to our patients.

The surgery

Retinal detachment surgery is required for a retinal detachment repair, and may involve the use of scleral buckles, vitrectomy, laser, cryo therapy (laser or freezing treatment to the retina), intraocular gas bubble or intraocular silicone oil. Retinal Detachment requires urgent referral for surgery.The type and timing of treatment is tailor-made to the type of retinal detachment, as these vary greatly.

Following retinal detachment repair, you may have a large gas bubble in your eye, which will dissolve on its own, or you may have silicone oil, which will have to be removed at a later operation. You may be required to posture so that the gas bubble or oil bubble floats up against the retinal tear to seal it whilst the laser treatment takes its time to stick the retina down.

Dr Bourke is one of a select number of ophthalmologists who specialise in retinal detachment having furthered his Retinal training at Moorfields Eye Hospital and Royal Liverpool Hospital between 1991-1995. Dealing with the very worst cases over the past 2 decades has allowed the development of techniques that almost always allow the retina to be re-attached at the time of surgery. Nevertheless, despite optimal treatment, there is a condition that can cause re-detachment of the retina (proliferative vitreoretinopathy). This is an abnormal wound healing process, which leads to scarring on the surface of the retina, which contracts and pulls the retina off.

It is also possible that other biological processes that start as a result of retinal detachment could affect your vision. These include: distorted vision, double vision and cataract. Most of these can be rectified, however sometimes the vision remains poor despite excellent surgery.

If treatment of a retinal detachment is not undertaken the eye will go blind. With retinal detachment repair, over 95% of cases are successfully re-attached with one retinal reattachment operation.

Vitrectomy is performed to remove the vitreous jelly and to release the traction on the retinal tear. It is often accompanied by the use of a gas bubble or silicone oil as tamponade (ie. to reattach the retina).
Scleral Buckle is sometimes required to help buttress the retinal tear. A scleral buckle is a silastic band that is sutured to the sclera and covered by the conjunctival lining of the eye.
The Gas Bubble is used to reattach the retina and to help clamp the retinal tear in place whilst waiting for the laser and cryotherapy treatment to attain maximum adhesion. Having the gas bubble in the eye does not harm the eye but it does prevent you from seeing for a short duration. During the post-operative period, the gas bubble will get smaller and will disappear on its own. During this time a line will be seen which moves as you move the eye. As you move the eye up and down, the gas bubble will move around and this will change the vision, usually obscuring the vision when you look straight down. The gas bubble and normal intraocular fluid are acting like a spirit level within the eye. This line will gradually travel out of the line of sight over a period of weeks and eventually will disappear. Whilst the gas bubble is getting smaller, it is not uncommon for the gas bubble to break up into smaller bubbles so that you would see multiple little bubbles. This is not a cause for concern. Whilst the gas bubble is in the eye, you should not travel to high altitudes (eg aircraft, mountains) due to the fact that it will expand at high altitude.
Silicone Oil performs the same function as a gas bubble in that it allows the retinal tear to be clamped in place whilst waiting for the laser and cryotherapy treatment to achieve maximum adhesion. The advantage of silicone oil is that you can still see through it although it does put the eye a little out of focus. The other advantage of silicone oil is that you can fly and move to any altitude without any problems (ie silicone oil does not expand, whereas gas bubbles do expand when you travel to high altitude areas). The other advantage of silicone oil is that it can be left in the eye for quite a few months to allow the eye to settle down and to see if any scarring process (proliferative vitreoretinopathy) is likely to continue. Silicone oil is usually removed at a later stage to achieve the best level of vision.
Laser/Cryoretinopexy. This procedure is required with retinal detachment to ‘spot weld’ the retina back down to the wall of the eye. For technical reasons, laser is used for the posterior aspects of retinal tears where a good laser spot can be focused on the retina. For the more peripheral aspects of retinal tears, cryoretinopexy is used.

It should be noted that retinal detachments come in a myriad of forms and the above treatments are tailored for the patient’s specific retinal detachment problem.