Retinal Detachment Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Retinal detachment surgery is an urgent ophthalmic procedure performed to reattach the retina — the light-sensitive neural tissue lining the inner posterior eye — after it separates from the underlying retinal pigment epithelium (RPE). Without prompt surgical treatment, progressive retinal detachment leads to permanent and irreversible vision loss. The retina cannot survive without the metabolic support and oxygen provided by the choroidal blood supply beneath the RPE.

Three primary surgical techniques are employed, each suited to different detachment characteristics: (1) Pars plana vitrectomy (PPV) — the most widely performed modern approach, involving removal of the vitreous gel and internal tamponade; (2) Scleral buckling — placing a silicone band externally around the globe to indent the eye wall and close retinal breaks; and (3) Pneumatic retinopexy — office-based injection of an expansile gas bubble combined with laser or cryotherapy, appropriate for select superior detachments. The choice of technique depends on the type of detachment (rhegmatogenous, tractional, or exudative), the location and number of retinal breaks, the extent of detachment, and patient-specific factors including lens status, prior surgery, and whether the macula is involved. Early intervention — ideally within 24 hours of macular involvement — is the single most important determinant of visual outcome.

Retinal detachment surgery is required for all patients with progressive rhegmatogenous retinal detachment (caused by a full-thickness retinal break allowing liquefied vitreous to pass beneath the retina), tractional retinal detachment (where fibrovascular membranes from proliferative diabetic retinopathy or sickle-cell disease pull the retina away from the RPE), or exudative (secondary) detachment that fails to resolve with treatment of the underlying cause.

High-risk groups who warrant heightened surveillance and urgent assessment for any visual symptoms include: patients with high myopia (short-sightedness greater than −6 dioptres, who have thinner peripheral retina); those with a history of retinal tears or lattice degeneration; patients who have undergone cataract surgery (posterior capsular rupture increases risk 5-fold); individuals with a family history of retinal detachment; and those with a prior detachment in the fellow eye (10% risk in the other eye over 10 years). Anyone experiencing sudden floaters, photopsia (light flashes), or a visual field defect ('curtain') requires same-day emergency ophthalmic assessment, as macula-on detachments must be operated on urgently to preserve central vision.

Vitrectomy (most common technique): The patient receives topical anaesthetic drops and either local peribulbar block or general anaesthesia. Three microincisions (23 or 25 gauge, approximately 0.6 mm) are made in the pars plana region 3.5–4 mm behind the limbus. A wide-field viewing system (BIOM or RESIGHT) is mounted on the operating microscope. The vitreous gel is removed using a vitrectomy cutter operating at 5,000–10,000 cuts per minute. Subretinal fluid is drained through the break or via a posterior retinotomy. All retinal breaks are treated with 532 nm laser photocoagulation (2–3 rows around each break) or cryotherapy. The vitreous cavity is filled with a tamponade agent: SF6 (20% concentration, absorbed in 2–3 weeks), C3F8 (14% concentration, absorbed in 6–8 weeks), or silicone oil 1000 centistokes for complex or inferior detachments.

Scleral buckling: A circumferential silicone band (encircling buckle) or segmental radial buckle is sewn to the outer sclera under the detachment, indenting the eye wall to mechanically close retinal breaks and relieve vitreous traction. Subretinal fluid may be drained externally. Cryotherapy is applied to break sites. No entry into the vitreous cavity is required.

Pneumatic retinopexy: Cryotherapy or laser is applied to the break; 0.3–0.6 mL of expansile gas is injected into the vitreous cavity. The patient positions to float the gas bubble over the break. Suitable only for superior breaks in phakic eyes with no PVR.

If a gas bubble is used, patients must maintain face-down positioning for 1–2 weeks to keep the bubble in contact with the retinal break — this is the most challenging aspect of recovery. The gas bubble gradually absorbs over 2–8 weeks depending on the gas used (SF6 or C3F8). Flying is prohibited while the gas bubble is present due to expansion at altitude. Silicone oil, used for complex detachments, requires a second procedure to remove it. Eye drops are used for 4–6 weeks.

If silicone oil is used (for complex detachments, inferior breaks, or proliferative vitreoretinopathy), a second procedure to remove the oil is planned at 3–6 months, once the retina has stabilised. Patients with silicone oil must avoid oil-filled diving masks and may require a specific warning alert card. Follow-up visits at 1 week, 1 month, 3 months, and 6 months assess retinal status, intraocular pressure, cataract progression, and visual acuity recovery. Any sudden visual change, new floaters, or return of visual field loss should prompt immediate ophthalmology assessment.

The most significant complication is re-detachment, occurring in 10–15% of primary cases, usually within the first 6 weeks, requiring further surgery. Proliferative vitreoretinopathy (PVR) — scar tissue formation on the retinal surface causing tractional re-detachment — develops in 5–10% of patients and is the leading cause of surgical failure. Cataract formation occurs in virtually all phakic vitrectomy patients within 1–2 years as oxygen exposure accelerates lens opacification; phacoemulsification is often combined at primary surgery.

Raised intraocular pressure (IOP) from gas or oil tamponade occurs in 15–25% and is managed with topical medications. Endophthalmitis (intraocular infection) is rare at 0.05–0.1% but devastating. Silicone oil-related complications include band keratopathy, oil emulsification, glaucoma, and the need for a second surgical procedure to remove the oil, typically at 3–6 months. Scleral buckling can cause diplopia (double vision) from muscle imbalance in up to 3% of cases.

Anatomical retinal reattachment is achieved in 85–90% of cases with a single surgical procedure; with repeat surgery the cumulative anatomical success rate exceeds 95%. Visual outcome is strongly correlated with macular status at the time of surgery: macula-on detachments (macula still attached) achieve Snellen visual acuity of 20/40 or better in over 90% of cases. Macula-off detachments (macula separated for less than 24–48 hours) achieve 20/40 or better in 60–70% of cases, while detachments with prolonged macular involvement (greater than 1 week) show more variable recovery, with central vision often remaining permanently reduced despite successful reattachment.

For patients with proliferative diabetic retinopathy (tractional detachment), vitrectomy prevents progression to no light perception and stabilises the remaining vision in 70–80% of cases. The procedure is generally safe and definitive, with the vast majority of patients retaining useful functional vision long-term.