03 Sep Scleral Buckle vs. Vitrectomy
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,
Laser Treatment for Retinal Detachment
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.
Vitrectomy and Cataracts
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.
Kishore TinaniPosted at 22:09h, 03 September
Recently done PKP surgery on 25/7/2014 at sir.j.j grand medical college mumbai .when I went. For follow up doctor said that the cornea is thinning from one side which was due to high diabetes 403 after lunch which is controlled after medication to 110 after lunch. Please suggest me more precautions to be taken. My vision has returned 20% when will I get full vision.
Randall V. Wong, M.D.Posted at 08:19h, 02 October
Corneal transplants are really out of my specialty. Obviously, great job with the sugar control. Stay close and follow advice of your doc.
All the best to you.
Barbara ThomsenPosted at 11:24h, 08 September
Thank you so much for your most helpful blog. You provided much helpful and insightful information while I was going through my five retinal detachments. After the fifth retina surgery, my retina remains attached and the oil is planned to remain to provide support. I had cataract surgery two years before the first detachment occurred and had great vision afterward.. However, after treatment with prednisone for a year for an autoimmune disease, I now have a post capsular cataract in my good eye and my vision is becoming more and more compromised. I also have glaucoma that is well controlled with medication. My glaucoma specialist encouraged me to wait before having laser surgery for removal of the cataract since I am no longer taking prednisone, hoping it might not progress after I was off the medication. It is getting worse, however, and I don’t know what to do. I am basically a one-eyed patient as the lens was removed when I had the fifth surgery when my retina was totally detached. My vision is getting worse in my good eye that now has a sub capsular cataract. Help! I don’t know what to do and value your opinion. Also, are some doctors more skilled in cataract removal than others?
Randall V. Wong, M.D.Posted at 22:11h, 21 September
There are many, many excellent cataract surgeons. Where are you located?
Lynne NewcombPosted at 12:58h, 16 September
I had a retinal detachment surgery with gas and scleral buckle about 4 years. Is it common to see light flashes now and then? It has been constant since the surgery, although it doesn’t affect my vision at all. The light flash resembles the light going across the screen of a xerox machine, if I had to compare it. My ophthalmologist didn’t seem concerned.?
Randall V. Wong, M.D.Posted at 22:21h, 21 September
If you’ve had the symptoms for a long time, I trust you’ve had several exams and everything is normal (no tears or retinal detachment). I’d have to rely on the opinion of your ophthalmologist as I can’t examine you.
PETER DEMPSTERPosted at 07:46h, 06 October
Thank you very much for your blog. My I first say that I trust my Retinal Surgeon completely, and this is not about his treatment. He is an excellent surgeon. I require some information from the General Public. I am Myopic and have had a retinal detachment in one eye which has been operated on.
Last year I flew in a jetplane (Jetstar Company) from Sydney to Melbourne and return . A few days after returning home I had flashing lights in my good eye. I had this checked by my Doctors and nothing was found abnormal.
I wish to travel about 600 miles soon. I am worried whether I should fly about 1.5 hours travelling time or by train
about 16 hours travelling time. Due to my eyesight I could not drive.
The inside cabin pressure of a jet is 8,000 feet. Could this affect my good eye?
Has anyone else had problems flying with their retina in a Jet.
Finally I repeat I trust my retinal Surgeon for his treatment.
Randall V. Wong, M.D.Posted at 10:18h, 07 October
In my opinion and experience, flying in an airplane with a change in atmospheric pressure has no effect in causing a retinal detachment. Patients are often instructed to avoid flying or going to the mountains, for example, when gas is placed into the eye to repair a retinal detachment – the gas could expand and cause an increase in eye pressure.
Simply flying – without gas in your eye is safe.
JohnPosted at 10:54h, 16 October
I have enjoyed reading your website and find it highly informative. I had a vitrectomy with gas bubble 9 weeks ago to correct a detachment in the left eye. I am awaiting cataract surgery for the expected cataract. I have noticed persistent small “speck” floaters since the surgery. I’ve been told they are “inflammatory cells” and “debris” from the surgery. They seem to be slowly fading over time, but are still clearly noticeable. Is the expectable?
Randall V. Wong, M.D.Posted at 17:43h, 22 October
Thanks for the kind remarks re: the website.
I can’t confirm that what you are seeing is in fact due to inflammatory cells/debris as I can’t examine you, but….as long as your retina remains attached, there is not much to worry about.
James MorperPosted at 15:43h, 21 October
Looking for a second or just general opinion.
1. Had a global rupture and detached retina with numerous tears in 12/2012 due to serious accident.
2. Had two surgeries in 1/13 to stop the bleeding,repair the rupture, and reattach the retina, along with laser surgery to repair the tears
3. The lens was removed, a scleral buckle was placed, and silicone oil was used. Also fitted with a contact with my Optometrist after a few months of healing.
4. Follow up visits had shown that the retina was holding
5. Developed in early 2014 a blood vessel growing from the repaired area toward the center of the eye and after 4 shots of Avastin over a few months, the growth was stopped.
6. Just within the past two months, the oil is emulsifying and the doctor would like to remove this. Additionally my IP was around 28 and has held there for approximately 5 weeks with drops of Alphalgan(sp?).
I read about the retina possibly detaching from the oil removal procedure and also was posed with a question by my optometrist, concerning the pressure and how it may relate to the trabecular meshwork. I am very pleased with my Ophthalmologist and the results and care throughout this past year and a half with my traumatic injury, but I am looking to understand any urgency as it relates to the emulsification and/or IP and the oil removal surgery.
Thank you in advance for your thoughts.
Randall V. Wong, M.D.Posted at 18:01h, 22 October
In my experience, emulsification does not occur that often, but removal of the oil is usual. I wouldn’t expect there to be problems with the pressure due to the removal of the oil.
There is always the chance of re-detachment when the oil is removed.
James MorperPosted at 14:05h, 23 October
Thank you for your quick reply. What would be some complications of oil emulsification? And do you recommend the use of 360 Retinopexy to possibly reduce the detachment of the retina?
Randall V. Wong, M.D.Posted at 07:26h, 25 October
Most of the complications of oil emulsification, per se, are probably going to be related to the cornea and glaucoma – I’d ask your doc to see if he/she feels if there are any problems developing.
I usually recommend 360 retinopexy (laser) before removing oil.
James MorperPosted at 12:50h, 27 October
Thank you for your time and comments. Appreciate it.
Randall V. Wong, M.D.Posted at 13:54h, 01 November
No problem. Stay well.
michellePosted at 21:47h, 03 November
Hello, in August2014 I had gotta the bacteria bacillus non -anthrax type in my left eye. After the first week I started to see flashes then floaters and finally blurred vision 3wks in. I was sent to a eye institute and admitted 12 days and had to have vinco antibiotic every 12 hrs until infectious disease and control felt comfortable that they had rid the body from the bacteria. As for my left eye, the infection even after the ejections would not go away so a vitrectomy and gas bubble was done on the 10th day. About 2wks later I saw the curtain closing. My retina had detached. My follow ups didn’t notice the tear. I understand tho, seeing how cloudy the pictures and damaged the lens was. Idk, So emergency surgery was done 3 days later. I received a buckle and oil. But so far it’s holding up fine. They removed the lens and didn’t want to replace it at this time. My eye was giving up. But now I am seeing light and actual images for the first time in 2months without a lens. I do however see wavy lines and the color only comes threw my side views. Will my vitreous come back if I take out the oil? Or will it be better to leave in? The vision comes and goes threw my central vision what does that mean?
Randall V. Wong, M.D.Posted at 11:46h, 06 November
I really can’t assess without an examination. Your vitreous will not regenerate – with or without the oil.
It is difficult to truly assess your vision with oil in place – I can’t predict if your vision will improve if the oil is removed.
FaridPosted at 03:03h, 30 November
Hi. I had a retinal detachment surgery with gas and scleral buckle, vitrectomy and laser in my left eye about 2 weeks ago. Now after disappear the gas, I have a distorted vision in my central vision. I see vertical and horizontal lines break at a point. Also see the persons as a caricature with a small head and big body. I was Myopic and now it is degraded. Also I see a small black area bottom of my field of view(where I had tear retina).
My doctor say it takes time and this distortion will be recovered. What is your experience and opinion? If it would not recovered, is there any solution? Thank you for attention.
Randall V. Wong, M.D.Posted at 10:13h, 22 December
Sorry for the delay.
There are so many causes of distortion, I would only be guessing without the ability to examine you. It definitely sounds as though your macula might have been detached – how has it improved over the past couple of weeks?