Success of Retinal Detachment Surgery

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Success of Retinal Detachment Surgery

JD_CO0084 RDMy idea of a successful operation to repair a retinal detachment is when I don’t have to operate a second or third time.  It’s not whether or not your vision improves…that is actually beyond my control!  Vision can only improve if we first reattach the retina.  In other words, visual improvement is a by-product of successful reattachment of the retina.

Anatomic Success

A retinal detachment means the retina becomes anatomically separated from its normal position.  The goal of retinal detachment surgery is to reattach the retina and thereby achieve “anatomic” success, that is, getting the retina back to where it belongs.

Anatomic success simply means the retina has become attached…again, but there is no absolute correlation with function.  Though I may achieve anatomic success, this does not always translate into restoration of vision.

Functional Success

From a patient’s perspective, the retinal detachment can cause loss of vision, be it central and/or peripheral vision.  It is hoped that successful surgery will lead to full return of the vision, that is, improvement of function.

Anatomic success is necessary for functional improvement.  In other words, the only hope of seeing better is to get the retina attached.

Ways to Fix Retinal Detachment

There are a variety of eye operations to fix retinal detachments;  pneumatic retinopexy, scleral buckle and/or vitrectomy eye surgery.  All have different advantages.  For instance, pneumatic retinopexy can be performed in the office, a vitrectomy alone requires less “operating” on the eye, whereas a scleral buckle, the oldest remedy, is technically more challenging but has long been a favored choice.

They all have different success rates, too.

There are a variety of retinal detachments (not all retinal detachments can be fixed the same way), yet the only comparison between techniques is by the re-operation rate…how often must the procedure be repeated?

They are never compared by resultant vision.

What Does This Mean?

There are too many variables leading to the eventual decision on how to fix a retinal detachment.  In short, there is no “best” way to fix a retinal detachment involving visual outcomes.  Each case and patient are different.  The surgeon’s objective is to use the best technique to achieve anatomic success.

Regardless, keep your expectations aligned.  The vision can only be improved if anatomic success is achieved.  That is the primary goal of retinal detachment surgery…getting the retina to be reattached.

Vision is not a direct goal.


Randall V. Wong, M.D.
 
Ophthalmologist, Retina Specialist
Fairfax, Virginia

 

Comments
  • anonymous January 31, 2013 at 10:47 pm

    Hello Doctor,

    I recently had a successful surgery to fix a detached retina with a scleral buckle operation.

    Everything is fine, and I’ve had a few checkups to verify that everything is okay. It’s been almost 8 months at this point.

    I’ve been embarrassed to ask my doctor about this, and I haven’t found any resources on the web, but I was wondering if there are any drugs that might be harmful to my eyes ?

    In particular, marijuana, but there are times when I do partake in some MDMA ( ecstasy ) and occasionally some other substances as well.

    These are not things I abuse, and I’m not encouraging this behavior, but I feel like it would be good for people to know if there is something out there that is harmful for the eyes.

    I’ve seen these questions asked on other forums, with no set answer except something along the lines of ‘ well, it’s best if you just ask your doctor ‘.

    A response would be greatly appreciated, thanks for your assistance in advance.

  • Dee Shepherd February 1, 2013 at 8:25 am

    Hi there, Is there an average time frame within which a retinal tear can progress to causing retinal detachment. I have searched the internet unsuccessfully to find a timeline or stages of retinal detachment following posterior vitreous detachment/tearing. I would be delighted to hear your comments

    • Randall V. Wong, M.D. February 2, 2013 at 4:40 am

      Dear Dee,

      1. Not every retinal tear causes a retinal detachment.
      2. The retina can detach as quickly as 24-48 hours after the tear develops…it can be pretty fast.

      r

  • Jasmin De Leon February 25, 2013 at 2:23 am

    Hi,
    My son was diagnose with a stage 4 of retinopathy of prematurity when he was 5 months old. He is now 4 years old. Do not have any vision on his right eye and low vision on his left. It breaks my hear t to hear him say his eye doesn’t work. would there be anything that could be done in the future, to fix his retina? He has had 3 surgeries, 2 of them we to stop the detached retina from leaking and tearing.

  • Anita March 9, 2013 at 5:03 pm

    Hello Dr. Wong,

    Last December my 67 year old father spotted a new floater in his left eye (L -1.75; R -3.00; my grandfather had had bilateral retinal detachment). He had himself checked by an ophthalmologist who gave him an all clear. Three weeks later he had symptoms of a retinal detachment (watery vision in the periphery) in his same eye. The retina specialist could not confirm a detachment. She thought it might just be a ‘droopy eye’. A couple of days later my dad went back to her and insisted that she take another look. Sure enough there was a retinal detachment, which she found this time around. The next day she operated on him (vitrectomy, silicone oil, scleral buckle). She insisted that the detachment was not due to a tear or a hole.

    My questions are:
    1) I realize that retinal tears can go unnoticed by even the best experts in the field, but how often does a retina specialist miss an RRD?
    2) If you were in my position, would you advice your dad to get a second opinion from a different retina specialist before the silicone oil is removed (scheduled within next 2 months, i.e. before the end of 4 months from surgery)? While I don’t want to second guess the retinal surgeon at this stage, but going from not spotting the detachment to using silicone oil in the very first surgery also remains unclear to me.
    3) My father also had two holes in his right eye’s retina treated with laser. Assuming the left eye had the RRD following a recent PVD, I am assuming there is a reasonable chance the PVD might occur in the right eye anytime now. If you were in my father’s position what would you do? Is there a fool proof way for a retina specialist to track the progression of PVD?
    4) If you were in my dad’s position and you developed PVD like symptoms (floaters/flashes) in the right eye, would you go to two separate retina specialists just to be sure they don’t miss something. The last thing my dad wants is a repeat of what just played out for his left eye. (Assuming any given retina specialist misses retinal tears 20% of the time, then getting two independent opinions might reduce the chances of something being missed to 4% (i.e. 100% – (20% x 20%) = 4%).

    I am very concerned and would greatly appreciate your response.

    • Randall V. Wong, M.D. March 23, 2013 at 2:12 pm

      Anita,

      Retinal detachments are sometimes difficult to diagnose. I’ve had a few times where my patient insists there is a detachment and, yes, I’ve missed it. Both times were in patients with previous retinal detachments, that is, they knew exactly what they were seeing.

      1. Not often, but sometimes very difficult.
      2. Uncertain to me, too, but I don’t know the details from a surgeon’s point of view. Second opinions are always a good idea, and for both sides.
      3. No certain way to track progress of PVD. Chance of tear occurring is highest within the first six weeks after a PVD. Every eye gets a PVD.
      4. Find one you like and trust.

      Randy

      Randall V. Wong, M.D.
      Ophthalmologist, Retina Specialist
      Fairfax, Virginia
      http://www.TotalRetina.com
      http://www.RetinaEyeDoctor.com

  • Christina Kavanagh May 1, 2013 at 11:52 am

    Dear Dr. Wong, I had 2 retinal detachments last year, the second one repaired with a scleral buckle. This was followed by a macular hole that I noticed 1 month later but could not be confirmed by OCT b/c 3 month gas bubble still there. .After the bubble absorbed, a dense cataract developed, so that had to be removed, then wait a month to have a YAG procedure done and then finally OCT confirmed MH and surgery was done.. Fortunately, my MH closed although I still have a very small central scotoma and wavy distortion, Ever since the 3 month gas bubble absorbed following my MH surgery I have difficulty focusing my eyes together. Directly after my MH surgery my eye was up in the outer right corner of my eye, but gradually came down however the strabismus doctor I was referred to says it is still higher than the other eye and to the side despite my muscles working to keep it aligned. I have difficulty with just about everything, walking, (especially in crowds, reading, watching TV and I can’t drive, it is too disconcerting and I am afraid of being an unsafe driver. I have had 3 pairs of eyeglasses since, including 2 pairs with prism that only made things worse. The strabismus specialist suggests although eye muscle surgery could be done first, he recommends removing the buckle, waiting a few weeks for healing and evaluating vision and then he will do muscle surgery. I am very scared of doing this, but the thought of living out the rest of my life with the doubling and trouble focusing I have is very depressing.

    The retina doctor told me she will remove the buckle, that my retina looks flat and good. She also told me I would have a 10% chance of another detachment..

    My questions for you are: Does that mean 10% chance right after surgery or 10% for the rest of my life? Also does having a scleral buckle protect you from future re-detachments for the rest of your life? Have you ever had patients have another RD even though they have a scleral buckle?
    Have you removed any buckles for similar symptoms and if you have, how was the outcome for your patients?

    Dr. Wong I appreciate your time so very very much!! Deciding to remove the buckle and risk a re-detachment is very scary, I feel like your input may help me make a better decision.
    Christina

    • Randall V. Wong, M.D. May 11, 2013 at 4:52 pm

      Dear Christina,

      1. I have never, to my knowledge in 22 years of practice, had a patient redetach after scleral buckle removal. I have had patients redetach for other reasons.

      2. I believe your chance of detachment over your lifetime to be somewhere around 5-10%, but in the OTHER EYE! Probably much less so in the eye with the initial detachment.

      3. I have had only two patients complain of double vision after scleral buckle surgery. I suspect one of those had strabismus beforehand.

      Randy

      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia
      http://www.RetinaEyeDoctor.com

  • Dee shepherd May 31, 2013 at 8:32 pm

    Dear Dr Wong
    In an effort to better understand the way retinal detachments progress from vitreous detachments and tears, I posted a question earlier this year which you very kindly answered and indicated the speed with which this can happen. I am still trying to work out if there is an average time span in a situation where there are multiple tears from PVD. Once there’s tearing on average how long does it take for enough fluid to build up behind retina to cause detachment. Is there ordinarily a crucial window of time within which to repair the tears to prevent retinal detachment? I would be extremely grateful if you could clarify this. Thank you for your time.
    Dee

  • Eric September 5, 2013 at 11:55 am

    Dr. Wong,

    Both my retinas are detached, my right in February and my left in April. I have a few questions for you and I hope you can answer them for me.

    1. I got a scleral buckle surgery on my right eye and the gas bubble was also injected at the same time. But the vitreous was not removed. Since the surgery, my vision gets blurry several times a minute because the vitreous that is mixed with blood or other material is floating around and causes this blurriness. My doctor tells me that I need to get a vitrectomy and I would like to get it soon. But I have a few questions in regards to this. First, when I get a vitrectomy to remove that big chunky floater, does the gas bubble need to be injected again? Second, after this vitrectomy, will my eye develop cataract eventually for me to get a cataract surgery?

    2. I got a scleral buckle surgery and vitrectomy on my left eye. The silicone oil was injected and was scheduled to stay there for about five months. My doctor tells me that she has never seen that big of a retinal detachment in her 17-18 years of practice. Soon after the surgery, cataract got developed which was expected. So, in July, after three months of buckle surgery and vitrectomy, I got a cataract surgery. But the surgeon couldn’t complete the surgery after removing my original lens because he realized that there is a small hole in the posterior capsule and the oil was flowing out through it. He sutured and closed it up. So, my retina specialist removed the oil in August and injected gas bubble which was done 1. 5 months sooner than it was originally scheduled. I am also noticing that my iris is moving to the edge of my eye towards the direction of my ear. My questions in regards to this. First, what is the chance of my retina staying attached in this case? And what is the chance of cataract surgery being successful without causing retinal detachment? Second, will my iris return to its normal place in the center of my eye?

    3. I got rear ended in the middle of March which was just one month after my retinal detachment surgery on my right eye. At the time of the accident, my left eyebrow area hit the inside the car frame pretty hard and bled. I went to the doctor to see if my right eye was okay because of the recent surgery I got. He took a look at it and said that my right eye retina is attached. But he saw an atrophic hole in my left eye even though he didn’t see any tear or detachment. After about three weeks of the accident, I saw a bunch of floaters on my left eye, rushed to the hospital and got the laser treatment. But two weeks later, I had a huge detachment and got the surgery that I described in #2 above. My question in regards to this is this. Is it possible for the accident to have anything to do with the tear and the detachment on my left eye? My doctor believes and tells me that if the tear or detachment was going to happen because of the accident it will happen immediately after the accident and not two or three weeks later. What do you think?

    I would like to thank you in advance for your time in answering my questions. It’s been a pretty tough year due to all these.

    • Randall V. Wong, M.D. October 8, 2013 at 2:55 pm

      Eric,

      Wow. Tough year indeed.

      1. I personally wouldn’t see a need to inject gas at the end of the vitrectomy. Every eye gets a cataract, to me it’s a moot point. I also don’t know how much of a cataract you have at this point.

      2. Can’t answer this. Not really understanding what you mean. Cataract surgery is usually very successful and does not cause a retinal detachment.

      3. Tough question. I would side with your doctor on this one.

      Sorry, not much help. If I were able to examine you, I might be more helpful.

      Randy
      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, VA 22030

      http://www.TotalRetina.com

    • Ryan February 27, 2019 at 8:51 pm

      Dear Dr. Wong,

      Hi doctor thank you in advance for any help you can give. On Jan 10 I underwent getting a scleral buckle, vistrectomy, and retinal attachment surgery on my right eye. My optamalogist was optimistic to start as he believed I had a tear for a few years and didn’t know how bad my eye was until he could look at it.
      He was successful on all of the operations. I did have quite a bit of scar tissues as he expected, but he was able to reattach my retina and I was seeing better. This lasted for 4 weeks. On my 6 week check up he discovered there part of my retina was separating again. He wants my scar tissue to heal and try again now that my scleral buckle is on and part of the retina is attached and there is oil in my eye.
      I have 2 questions.

      Is there a better chance of the retina statins now that the buckle is on already?

      My eye is still dilated it’s been 6 weeks. He said it’s ok and that sometimes that takes time after the surgery. My partner is a doctor and was afraid of nerve damage?
      Thank you again in advance.

      • Randall Wong, M.D. February 28, 2019 at 2:55 am

        Really tough to predict, but a scleral buckle is not a bad thing. Don’t worry about dilated pupil, there is really nothing to do, there can be many reasons for this, but not to worry if you are seeing well. Sorry, limited response given I can’t examine you. r

  • Anonymous December 31, 2013 at 5:00 pm

    Hi Doctor,

    I left a message above back on January 31st of 2013, and my post went unanswered.

    Do you know if there are any drugs that can cause a retinal detachment ? ( marijuana, ecstasy, alcohol, nicotine, cocaine, magic mushrooms, etc. )

    Please let me know when you get a chance. Thank you.

  • John January 2, 2014 at 6:01 am

    Hi Randall. I experienced a chronic retinal detachment a couple of years back. I had the scleral buckle first, but more of my retina detached so i had to have vitrectomy. A total of 4 surgeries on that eye. My retina looks like a battlefield but no PVR, and my retina is attached as of a recent eye checkup. I have had these strange symptoms since before my first surgery. Some kind of flicker/shimmer in the detached area, and sometimes light flashes that move slowly from the periphery to the center. I have on my own accord understood that this must be some kind of nerve damage to the retina causing these symptoms, but no one else can explain them and I have learned to live with it. Have you heard of something similar.

    Another question is the scleral buckle. It feels like quite a crude operating technique with eye elongation and whatnot. I was a – 5.5 diopter before surgery and was – 8.0 diopters after the scleral buckle. It went down to about – 6.5 diopters after vitrectomy, and im now. I was wondering. Will my eye continue to elongate after the scleral buckle? It would be logic that the pressure it exerts on the eye pushes it in a horisontal direction, or will it stop and stabilize like before the surgery? And what about reduced blood flow to the peripheral retina? Wont this afflict the retina in a bad way long term?

    Sorry for all the questions doctor, but these are questions my doctor doesn’t seem to know anything about, and you look like a real resource on the subject, and answers a lot of weird questions 😉

    I understand if you don’t know and dont have time to answer all my questions.

    John

    • Randall V. Wong, M.D. January 4, 2014 at 3:24 pm

      John,

      Obviously you’ve read up on your condition. Not too many understand PVR, doctor or otherwise.

      1. Flicker/shimmer – probably from either recently reattached retina or from different currents within the vitreous. Some residual vitreous is left to the peripheral retina that was detached and the different currents create different vector forces…causing stimulation of the retina, or, flashes.

      2. A -1.00 increase in myopia is pretty optimal for a scleral buckle. I don’t think I agree that the vitrectomy influenced the myopia. Myopia is due to the elongation of the eye by the physical changes induced by the buckle and not so much any pressure (pressure would “push” the eye equally in every direction, think a basketball – bounces uniformally regardless of where it contacts the ground).

      3. I don’t think there is any reduced blood flow to the retina.

      Hope this helped.

      Randy

      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia 22030

      TotalRetina.com

  • Carol Nemec January 29, 2014 at 2:19 pm

    My husband has had detached retinas in both eyes and has now developed cataracts(which I understand is very common) He will be having surgery to remove them. The doctor makes it sound that the success rate is not as good as far as his sight improving much due to the detaches. How do you feel about that?
    Thanks

  • Eric March 28, 2014 at 2:57 pm

    I had recurrent retinal detachments in my right eye, but the eye has finally been stabilized. A cataract developed during the process and I had an IOL implanted. I had two questions.

    1. The doctor said he had to implant the lens from “underneath” in a non-standard way due to the vitrectomy, and the lens placement was therefore more complicated. Can you give me your take on what he meant by that?

    2. Now that the bubble is gone I see that the image in my right eye is severely offset from the image in my left eye. The image formed in my right eye is displaced down to almost the lower right corner of the field of view (assuming the image in the left eye is centered. Can you give me a second opinion on why this is happening?? It is making the eye useless, and worse it’s interfering with my normal vision due to severe double vision. The doctor said it might be due to the “band” he put in the eye, but note that is NOT a scleral buckle (he inferred the band was placed there during the cataract surgery, possibly to hold the lens in place).

    He said give it a couple months and the images should recenter, however I can’t see how that would happen. Failing that, is there a surgical procedure than can be done to recenter the images? I was told prism glasses might help “a bit”, but I have no desire to go that route and still have some displacement and distortion.

    – Eric

    • Randall V. Wong, M.D. April 2, 2014 at 7:11 am

      Eric,

      1. No clue about “underneath” – ask him for the clinical name of the procedure.

      2. Again, ask him for a more clinical description. Too many things could cause your description.

      I’m not trying to evade your questions, but too many things could cause your symptoms…and I can’t examine you.

      Randy

      Randall Wong, M.D.
      Retina Specialist
      Fairfax, Virginia 22030

      http://www.VitrectomyForFloaters.com

    • Peter E January 3, 2019 at 1:05 am

      Hi Eric: How did you make out on the “centering” issue? I had vitrectomy done a couple weeks ago and have exactly what you describe — as the affected eye gets better my overall vision gets worse! Having said that, I think as each day goes by that it is centering itself better and better. Hope yours got better and (obviously( mine too!

      • Randall Wong, M.D. August 20, 2019 at 7:04 pm

        Sorry for the delay. Did you have resolution?

        r

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