This is a recent question I received via email. It brings up a few good points about choosing scleral buckle vs. vitrectomy to repair a retinal detachment. I receive many questions via the comments section after an article. This time, I’m trying something new and making the question a part of the post.
Dear Dr. Randall Wong,
I am not sure whether you do online diagnosis if I send you some
diagnostic data (fundus photo) from my retina doctor. I know online
exam will never be complete, but I wanted the opinion from a highly
regarded retina doctor like yourself.
I was diagnosed with a retinal detachment on the nasal inferior side.
This is a macula on retinal detachment. My doctor used laser to
prevent the detachment from spreading further into the macula. He
couldn’t completely seal off the rest because of the subretinal
fluids. After about 1 week of subretinal fluid not going away, he
recommended scleral buckle surgery but allowed me to look for a second
I did ask about Vitrectomy and he said, there’s high risk for
cataracts and it is more expensive than scleral buckle due to the high
end equipment used.
What is your take on my type of retinal detachment? Should I do
Scleral Buckle or Vitrectomy? I would gladly send my data over to you
if you request them.
Thank you for your time,
In this case, it seems that a laser was first attempted to “wall off” the retinal detachment and prevent it from spreading. The rationale for doing so is similar to containing a forest fire…dig ditches around the fire to prevent the spread.
I personally rarely treat retinal detachments in this fashion. I don’t feel that there is anything wrong, but I’ve seen too many “walled off” retinal detachments spread, albeit years after the retinal detachment.
In my opinion, simply lasering around the retinal detachment does not fix the problem.
Without complicating the matter too much, vitrectomy to repair retinal detachment requires the use of intraocular gas and head positioning after the surgery. Often, the gas can cause cataract though vitrectomy is an excellent choice for fixing the retinal detachment.
I can’t make a remark about the cost. You’ll have to check in your own particular area. I think insurance companies may pay the same or similar rates based upon the fact that the same procedure code is used for scleral buckle and vitrectomy.
There are two ways to use a scleral buckle to repair retinal detachment; with gas and without.
Scleral Buckle With Gas
After placing the scleral buckle around the eye, gas is injected at the end of the case. After the gas is injected, proper head positioning is required to keep the gas pressing on the retinal tear. Remember, the gas can cause cataract.
Scleral Buckle Without Gas
This is the original method used (way back when) to repair a retinal detachment. The scleral buckle is placed around the eye, no gas is injected and the retina often reattaches. In this way, gas is avoided and so is early development of a cataract.
What Does This Mean?
I can not make an online diagnosis nor review your case.
For me to make a diagnosis online, without examination, would be impossible. I get many, many requests for a specific opinion and diagnosis based upon an email or comment on the website. It’s impossible. I also want to avoid the liability.
In this case, for instance, I can talk about retinal detachments and my approach to repairing them, but without making specific judgements about this specific patient.
Overall, I can NOT review your specific documentation or studies. It simply takes too much time, involves potential liability by possibly starting a doctor-patient relationship, and I still can NOT examine you.
On rare occasion, I could be retained to such work.
With regard to fixing the retinal detachment, there are many ways to repair a retinal detachment.
Everyone gets a cataract eventually – with or without retinal detachment surgery.
Retinal detachments can lead to permanent blindness, cataracts do not.
Every effort should be made to repair the retinal detachment without worry to cataract, or even cost. If all things are equal, then, and only then, would I consider cost.