Call Us: 703.273.2398

Tag Archives: Retinal detachment

NFL Coach Zimmer Gets Retinal Detachment | What Can We Learn?

Retinal Detachment | Jireh DesignsNFL coach of the Minnesota Vikings, Mike Zimmer, just had a retinal detachment to his right eye.

He has had several “surgeries” over the past 30 days to the same eye.  While the exact details are not known, there is a lot we can learn from his recent experience.

What we do know is;

  1.  A retinal tear was discovered and treated around October 31.
  2. A second operation was performed a week later.
  3.  Emergency surgery for a retinal detachment was performed on November 30.

Retinal Tears Cause Retinal Detachment

All retinal detachments start with a retinal tear.  It has been my experience that most retinal tears simply “happen” and without trauma.

Retinal tears can happen to anyone.  Retinal tears usually, but not always, are associated with sudden onset flashes and floaters, but they can be asymptomatic.

This may have happened with Coach Zimmer.  Several accounts stated that his retinal tear was discovered after he scratched his cornea.

No, corneal abrasions can not cause retinal tears.

Treatment of Retinal Tears

The ideal treatment of a retinal tear is laser.  If laser is not an option, due to the location of the retinal tear, cryotherapy, or freezing, is an excellent treatment.

Both work equally well in treating retinal tears in situations where there is no element of retinal detachment.  Cryotherapy may be more uncomfortable.

I do not know if the second surgery was needed because additional tears were discovered or he developed a retinal detachment.

What is important to highlight is that additional retinal tears can occur and/or a retinal detachment could develop after treatment of an initial tear.

Treatment of Retinal Detachments

There are several ways to treat a retinal detachment.  Depending upon the location of the retinal tear causing the detachment, intraocular gas may be injected into the eye which requires specific head positioning afterwards to keep the gas pushing on the retinal tear.  This is an “in office” procedure.

Two other ways to fix a retinal detachment include a vitrectomy and/or scleral buckle.  These may be used along with intraocular gas, too.

Regardless of the procedure, if intraocular gas is used to repair the retinal detachment, airplane flight or traveling to higher elevations is not possible.

Too rapid a decrease in atmospheric pressure can lead to expansion of the gas inside the eye.  If this occurs too rapidly, the eye can not adjust to the increase in eye pressure caused by the expanding gas.  The high pressure could prevent normal blood flow into the eye.

This explains a few remarks about his driving to Florida for the game against the Jaguars.  No remarks about head positioning.

“Emergency Surgery”

Not all retinal detachment surgery is an emergency.  A retinal detachment starts off small and can spread.  If the macula, the functional center of the retina is attached, but may become detached by waiting, it can be an emergency.

I wish Coach Zimmer well.  I wanted to highlight his retinal detachment to emphasize a few points about retinal detachments in keeping with the headlines.




Vitrectomy for Retinal Detachment

Retinal Detachment | Signs, Symptoms and Treatment

Welcome!  I’m Randy Wong.  Thank you very much for watching this video.  Today we are going to talk about retinal detachments.

We are going to talk about;

  • The definition of a retinal detachment
  • What it can cause – the signs and symptoms
  • Surgery to fix a retinal detachment
  • Timing – when is the best time for surgery?

I hope you enjoy this.


Rhegmatogenous Retinal Detachment

Today we are going to talk about 1 of 2 types of retinal detachments.  We are going talk about rhegmatogenous retinal detachments and, by definition, that means the detachment is caused either by a retinal hole or retinal tear.

The hole or tear allows the fluid from the middle of the eye to communicate to a space underneath the retina.  So therefore if fluid accumulates underneath the retina through this hole or tear, the retina detaches.

Rhegmatogenous Retinal Detachment | Randall Wong, M.D.

Keep in mind a  retinal detachment is potentially blinding. So as we will talk about later, there is some urgency, or sometimes it’s an emergency, to fix a retinal detachment.

Symptoms of a Retinal Detachment

Symptoms of a retinal detachment include loss of your peripheral vision and usually the peripheral, or side vision, is involved first and the loss of vision moves centrally.

Flashes and floaters are also commonly associated with a retinal detachment because those are usually signs of a retinal tear that you may have sustained.

So, the recommendations are that new flashes and new floaters should be examined by your doctor and your doctor ought to be looking for a retinal tear because it is our job to try and prevent you from getting a retinal detachment if we can diagnose a retinal tear.

Again, symptoms of a retinal detachment include; loss of peripheral vision, especially if the vision loss is moving centrally, new flashes and new floaters.

What Do You Do?  (When to call your eye doctor)

What should you do if you think you are having a retinal detachment?  Maybe you’ve noticed an increase in flashes, an increase in the number of floaters or you are losing your peripheral vision.

My suggestion would be to let your own eye doctor know that you are having these new symptoms.

Once you arrive at your eye doctor’s office you need to get your pupils dilated.  By dilating your pupils your doctor can directly examine your retina and if he diagnoses, or she diagnoses, you with a retinal detachment, you are going to need surgery.

Unfortunately, there are not any drops or medicines to fix a retinal detachment.

Retinal Detachment | Surgery

There are three ways or three methods to fix a retinal detachment.  The first is called a pneumatic retinopexy.  The second is an operation called a scleral buckle and the third is an operation called a vitrectomy.

Pneumatic Retinopexy

A pneumatic retinopexy involves injection of gas into your eye.  The gas is used as a tool to help reattach your retina.  With a pneumatic retinopexy, depending upon the location of the tear, you may have to hold your head in a certain position.

This is sometimes face down, this is sometimes keeping your head straight up or to the right or to the left.  Again, the positioning depends upon the location of the tear.

A pneumatic retinopexy can be done in the office and can be very effective in fixing retinal detachments.

Scleral Buckle

A second way to fix a retinal detachment is with a scleral buckle.  A scleral buckle involves placing a silicone band or rubber around the outside of your eye.

Don’t worry, it will be completely unnoticed once you’ve healed up.  It’s intended to stay there.

Scleral Buckle to repair retinal detachment. Randall Wong, M.D., Retina Specialist, Fairfax, VA 22031

A scleral buckle is a very effective way to repair a retinal detachment and has been around for several generations.  It does require surgery and the most common complication of scleral buckle surgery is the increase in nearsightedness after the operation because your eye is actually made slightly longer.


A third way to fix a retinal detachment is with a vitrectomy.  Remember a scleral buckle involves placing an element or a piece of rubber around the outside of your eye.

A vitrectomy involves going inside the eye to remove the vitreous and the fluid underneath the retina.  Many times gas is also put into the eye at the end of the operation and just like pneumatic retinopexy you may have to hold your head in a certain position.

Vitrectomy for Retinal Detachment

Vitrectomy and Scleral Buckle

So there are three ways to fix a retinal detachment:  either with pneumatic a retinopexy, a scleral buckle or a vitrectomy.

Now, many times, surgeons may decide to combine both a scleral buckle and vitrectomy.  This is really personal preference and all surgeons have different indications as to when to perform both.

Timing of Retinal Detachment Surgery

The timing of retinal detachment surgery is really dependant upon whether or not the macula, which is the functional center of your retina, is, what we call “threatened.”

Another way to look at it is;

“What’s the chance of you losing your central vision if we delay surgery”?  If you have a retinal detachment which is not threatening your macula, therefore, it’s not threatening your central vision.  Waiting a day, or longer, probably is appropriate.

Another situation is where the macula is already detached which would mean that your central vision is already lossed.  Again, this is an urgent situation but not an emergent situation.

Probably the only time where retinal detachment surgery is an emergency is when you still have 20/20 vision, that is, your central vision is intact, but your doctor feels that if your retinal detachment were to enlarge your central vision might be in jeopardy.

Summary of Retinal Detachments

To summarize, we’ve talked about retinal detachments, specifically we’ve talked about rhegmatogenous retinal detachments and those are retinal detachments that involve a hole or tear in the retina.

We talked about symptoms of retinal detachments;  new onset flashes, new onset floaters or loss of your peripheral vision.

We talked about surgery.  The three options are pneumatic retinopexy, scleral buckle and/or vitrectomy.

We talked briefly about the timing of surgery…it’s all dependent if your central vision, or your macula is involved.

Thank you for watching!

I’m Randy Wong.  I’m a retina specialist in Fairfax, Virginia.  Thank you very much for watching this video.  I hope you enjoyed it.

By the way, if you have any questions or comments, please leave them at the end of this video on YouTube or at the end of the article if you are reading this on one of my blogs.

We will see you again!

Scleral Buckle and Vitrectomy to Fix Retinal Detachments

Vitrectomy for repair of retinal detachmentThere are several ways to fix retinal detachments.  The most popular operations include vitrectomy and scleral buckle.  These two procedures may be used singly, or in combination.

Nowadays, most retina specialists choose to repair retinal detachments using vitrectomy (and gas) alone.  While the scleral buckle has been around for several generations, I rarely use it alone to fix a retinal detachment.

Most often I use just vitrectomy, but when do I use BOTH vitrectomy and scleral buckle for repair of retinal detachments?

First of all, there is no dogma.  I’ve developed my own indications for using both procedures.  Hence, the elegance of “the practice of medicine.”

No Retinal Tear

All rhegmatoneous retinal detachments, by definition, are caused by a retinal tear or retinal hole.  This the more common type of retinal detachment.

One of the keys to successful surgery is find the retinal tear or retinal hole causing the retinal detachment.

Sometimes, despite my best efforts, I can’t locate the tear causing the retinal detachment.

Placing a scleral buckle increases the likelihood of successful reattachment AND the likelihood the retina remains attached.

Scleral Buckle to repair retinal detachment.  Randall Wong, M.D., Retina Specialist, Fairfax, VA 22031

Multiple Retinal Tears

Only one retinal tear is “required” to cause a complete retinal detachment.  In most cases, I find only one or two tears.  There are occasions where multiple retinal tears are found and in these cases, I am more than likely to use both vitrectomy and scleral buckle.

Also, in cases where the retina detaches again…I’ll choose to add the scleral buckle.

Old Inferior Retinal Detachments

In my opinion the most difficult situation to repair is a chronic (been there a long time, e.g. several months) retinal detachment located in the inferior portion of the retina (i.e. bottom).

Fluid underneath the retina tends to get thicker with time.  Usually the “subretinal” fluid is very watery (because it is basically water).  With time, however, this fluid accumulates protein and starts to thicken.

This thicker fluid is more difficult to remove.  Patients must keep a strict “face down” head position, but the chance of re-detachment increases due to these two factors.

Again, scleral buckles improve the initial success rate!

Scleral Buckle Has Side Effects

There are several side effects of scleral buckle;

1.  Increased myopia (nearsightedness) – by placing a buckle around the eye, the eye elongates, thus causing an increase in myopia.  Sometimes this can be dramatic and is difficult to correct with glasses or contacts.

If the refractive error is too different between the two eyes, your brain won’t tolerate this situation and you may see double.

2.  Possible Double Vision – the scleral buckle involves manipulation of the extraocular muscles – the muscles attached to the outside of the eye which are responsible for eye movements.  In theory, this could cause damage to one of the muscles.  It doesn’t happen very often, but it can.  I’ve found it to be surgeon related.

3.  Healing – the post-operative period is a little more complicated than when just performing a vitrectomy alone.  There is more swelling due to the surgery performed on the outside of the eye.  There may be additional discomfort (shouldn’t be frank pain).

4.   Time – while not really a side effect, the extra time required by your retina specialist to install a scleral buckle varies greatly.  This can add as little as 10 minutes to the procedure or increase the operating time to hours.

What Does this Mean?

These are my basic considerations when deciding to repair a retinal detachment with BOTH scleral buckle and vitrectomy.

While the success rate (in my opinion) is higher, we need to consider the risks and benefits overall.

I hope this was somewhat helpful in explaining a very complex and curious situation.

I look forward to hearing from you!

Scleral Buckle vs. Vitrectomy

Retinal detachment, Randall Wong, M.D., Fairfax, Virginia

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.

Scleral Buckle

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.



Vitrectomy and Scleral Buckle for Retinal Detachment | Retina Specialist Virginia


Retinal Detachments and Retinal Tear

Vitrectomy combined with scleral buckle is the last way to repair a retinal detachment.  This combines two separate methods to repair a retinal detachment.  Both vitrectomy and scleral buckle can be used alone to fix a retinal detachment.

Retinal detachments occur because the vitreous has caused a tear in the retina.  In addition, the vitreous may also be pulling on the retina to cause it to “tent” or detach.

You Are the Vitreous

Let’s pretend you are in the middle of a room with outstretched arms.  The room is the eye and wallpaper is the retina.  You are the vitreous.  Lastly, imagine long, taut pieces of tape extend from the tips of your fingers with the other ends on the wall paper.

If you lean to the left, you’ll pull and cause a tear in the wallpaper attached to your right hand.  If you move to the right, the opposite will happen, you’ll cause a tear to the left.

Scleral Buckle for Retinal Detachment

Whether the scleral buckle goes completely around the eye or is partially installed around the eye does not matter.  Whatever element is used to create the “buckling” effect of the eye, the result is to induce slack in the vitreous by reducing the internal diameter of the eye.

In our example, we are moving the walls of the room closer together. This causes the tape to slacken.  Now, you can lean left or right without tearing the wallpaper due to the slack.  Whatever forces there were pulling on the retina, they have been relieved.

Vitrectomy for Retinal Detachment

Vitrectomy is an intraocular operation where the vitreous is cut away.  Remember, it’s the vitreous which causes tears and exerts a pulling force to elevate and detach the retina.

It makes sense to cut away the vitreous which is pulling on the retina.  Returning to our example, if we simply cut the tape, leaning left or right would not cause pulling on the wall paper.

This is the value of vitrectomy.  It removes the forces of the vitreous pulling on the retina to cause tears and detachment.

After the vitrectomy is completed, it is customary to fill the eye with gas.  With proper head positioning, the gas should prevent redetachment by “plugging” the tears causing the retinal detachment.  The gas doesn’t really push on the retina to reattach.

What Does this Mean?

The best operation to reattach the retina from a statistical standpoint is to perform a vitrectomy with a scleral buckle.  It is the most complicated surgery.  With difficult surgery, however, the complications can increase.

This is probably why most surgeons do not always perform both procedures for all retinal detachments.  The more difficult the surgery, the more chance of complications.

Over the years, I have developed my algorithms, or practice, for certain types of retinal detachments.  In my experience, certain retinal detachments warrant longer and more complicated surgery, but probably yielding better outcomes than if we attempted different procedures.

Maybe this is called experience.



Vitrectomy for Retinal Detachment | Retina Specialist, Fairfax, Va.


A Vitrectomy Can Fix a Retinal Detachment
A Vitrectomy to Repair Retinal Detachment

Repairing a retinal detachment with vitrectomy has become more popular.  Vitrectomy can be viewed as fixing a retinal detachment from the inside of the eye whereas a scleral buckle fixes the retinal detachment from the outside.

Modern vitrectomy is comparable to cataract surgery in terms of safety.  For many retina surgeons, this eye operation is faster and more efficient compared to other operation which may involve a scleral buckle (you can repair a retinal detachment with only a scleral buckle or combine vitrectomy with a scleral buckle).

For patients, vitrectomy can mean a faster healing period with fewer side effects.

Vitrectomy for Retinal Detachments

All (rhegmatogenous) retinal detachments start with a tear or hole in the retina.  The vitreous can pull on the retina and cause a tear.  Sometimes pre-existing retinal holes can also cause a retinal detachment.

By removing the vitreous, the retina is allowed to more easily fall back into place.  Usually this is done with the aid of a gas injected at the end of the case.

This gas replaces the fluid, called a fluid-gas exchange, both in the center of the eye and underneath the detached retina.  Similar to pneumatic retinopexy, the gas must be positioned against the retinal tears/ holes, thus requiring  certain head positioning after the surgery (e.g. face down, head tilted to the right, etc.).

While the retina is almost always attached at the end of the operation, the gas keeps the retina attached until adequate scarring takes place to seal the retinal hole or tear.

The key to fixing most retinal detachments is finding the retinal tear(s) and treating them with laser or freezing.  This “seals” the tears and prevents redetachment from the same retinal tear.

Advantages of Vitrectomy for Retinal Detachment

Highly Effective – Vitrectomy is highly effective at repairing the retinal detachment.  By removing most of the vitreous, traction on the original tears is decreased and additional tears are less likely.

Most Retinal Detachments – Vitrectomy can treat almost any retinal detachment (perhaps not a giant retinal tear), whereas pneumatic retinopexy can not treat detachments associated with “inferior” tears, that is, tears located between the 4 and 8 o’clock position of the eye (impossible to hold your head in such a way so that the gas abuts these tears).

Rapid Healing due to minimal surgical trauma.  Very little cutting is required.  In fact, with 25 gauge systems, there are no stitches.  Compared to scleral buckle, vitrectomy is very, very gentle.

No Change in Refraction – the shape of the eye is not altered, therefore, there should be no change in your refraction.  With a scleral buckle, the eye becomes elongated causing induced myopia and/or significant astigmatism.

Short Surgery – This is can be a very quick procedure for selected cases, requiring less than 30 minutes to perform.

Disadvantages of Vitrectomy for Retinal Detachment

There really are no disadvantages of vitrectomy.  It can be used for almost any retinal detachment except with the possibility of giant retinal tears.

Head Positioning – Intraocular gas must be used with vitrectomy, thus, head positioning after surgery is mandatory.

Multiple Tears – vitrectomy alone may not be as good as vitrectomy combined with scleral buckle for multiple retinal tears, but I wouldn’t count this as a disadvantage.

When I use Vitrectomy to Repair Retinal Detachments.

I use vitrectomy for most retinal detachments.  I especially like to use vitrectomy for small localized retinal detachments where additional holes or tears are unlikely.

Surgery is very “easy” on the patient with 25 gauge vitrectomy as the surgery is sutureless, thus, there is minimal or no discomfort.  There is rapid healing and potentially fewer trips to the office.




Pneumatic Retinopexy for Retinal Detachment | Retina Specialist, Fairfax, VA

Rhegmatogenous Retinal Detachment with Retinal Tears or Holes
Retinal Tears are Located in the Anterior Retina (Grey Ring)

Pneumatic retinopexy is another method to fix a retinal detachment and is an alternative method to a scleral buckle and/or vitrectomy.

Pneumatic retinopexy was popularized in the 1980’s and has the advantage of being performed in the office.  It is not performed in the operating room as compared to a scleral buckle or vitrectomy – both of which must be performed as operations.

Pneumatic Retinopexy for Retinal Detachments

Every retinal detachment starts with a hole or tear in the retina.  These are so called “rhegmatogenous” retinal detachments.  These are the more common types of retinal detachments.

(Other retinal detachments, such as diabetic retinal detachments or proliferative vitreoretinopathy detachments, do not start with a retinal hole or tear.  These “traction” type retinal detachments are not relevant to this article.)

Retinal detachments develop as fluid migrates from the vitreous to the space underneath the retina.  The retinal hole or tear allows passage of the fluid.  As the fluid accumulates, the retina detaches.

By injecting air or gas into the eye, the passage of fluid may be blocked.  Think of the air or gas acting as a cork to seal the retinal hole or tear.

With proper head positioning, the head is held so that the gas presses against the retinal tear/hole.  Eventually, the retina reattaches and the hole becomes sealed with either freezing (cryotherapy) or laser.

Advantages of Pneumatic Retinopexy

In-Office Procedure – This surgery is performed in the office and avoids the usual rigors of scheduling OR time, etc.  This was the initial attraction to the procedure.  When introduced, most retina specialists preferred using a scleral buckle to reattach the retina – requiring an operation in the OR and much more time.

No Change in Refraction – The shape of the eye remains the same, thus, the refraction should not change.  In contrast, a scleral buckle causes the eye to increase in astigmatism and nearsightedness.

Disadvantages of Pneumatic Retinopexy

Not all retinal detachments can be repaired with pneumatic retinopexy.  Retinal detachments with multiple tears and those with “inferior” retinal tears are less likely to be fixed by pneutmatic retinopexy.

Redetachment rates are higher compared to scleral buckle and/or vitrectomy, probably because the vitreous is left in place and vector forces are not changed, that is, the same forces to pull on the retina and cause a tear are the same.

Cataract formation is higher due to the fact that intraocular gas comes into contact with the lens.

Discomfort – May require a retrobulbar injection to numb the eye.  This can be quite “uncomfortable” in the office setting as we can not offer sedation.

Time – An effective retinopexy can take hours to perform.  Depending upon the amount of subretinal fluid, size of the tear and location, repositioning of the head can only be done slowly.  Often times freezing the tear or laser can be cumbersome.

When I Use Pneumatic Retinopexy to Repair Retinal Detachment

I don’t often choose pneumatic retinopexy to fix a retinal detachment.  It is not my first choice.  I find it quicker and more effective to use a scleral buckle and/or vitrectomy to fix a retinal detachment.  The redetachment rate is lower and I can do a more effective job.

The operating room is a more controlled setting, I have the aid of anesthesia and am able to address any complications or difficulties along the way.

This flexibility is just not possible in the office.

Fixing a Retinal Detachment | Retina Specialist, Fairfax, Va.

Retinal Detachment Threatening the MaculaThere are several methods to repair a retinal detachment.  None is the best or right method and retina specialists all seem to have their own preferences.

In my opinion, the decision on what procedure(s) to employ depends upon the nature of the retinal detachment, skill of the surgeon and time required to perform the procedure.

Methods for fixing a retina detachment;

1.  Scleral Buckle
2.  Pneumatic Retinopexy
3.  Vitrectomy
4.  Scleral Buckle and Vitrectomy Combined

Scleral Buckle

This is the oldest method to repair a retinal detachment.  It repairs a retinal detachment by placing an “element” outside of the eyeball.  The scleral buckle (aka element) may be placed all the way around the eye or partially.

In either case, the goal is to get the sclera, or the wall of the eye, to indent or “buckle” (as in the way a road may buckle).  This buckling causes a decrease in the internal diameter of the eye thereby reducing traction, or pulling, on the retina by the vitreous.

Advantages of Scleral Buckle

Fewer Redetachments – after the initial operation, because stress is reduced in the vitreous, it becomes much more difficult for the vitreous to pull on the retina and cause additional tears.

The key to fixing any rhegmatogenous retinal detachment is to locate and treat the causative retinal tears and retinal holes.  This is not always easy.  Thus, in these complex situations, a scleral buckle may be more effective in preventing recurrent retinal detachment by foreshortening the amount of retina which may re-detach.

Disadvantages of Scleral Buckle

Required Skill – this may be the most difficult operation performed by a retinal specialist.   It can be difficult to position the buckle element precisely on the outside of the eye.  There is not a lot of space in the small eye socket which holds your eye.  This can take some surgeons…hours.

More Side Effects such as near-sightedness, anisometropia, double vision are all related to manipulating the eye and its muscles.

Swelling and Discomfort – quite simply the longer the operation, the more manipulation of the tissues, the more swelling and post-operative discomfort.

My Preferences for Using a Scleral Buckle

I prefer using a scleral buckle;

1.  Total retinal or large retinal detachment – with most or all of the retina detached, it is difficult to examine the retina thoroughly when looking for holes or teras.  This reduces the chances of my missing a retinal tear, and thus, reduces the chances of re-detachment.

2.  I have used the same type of scleral buckle, without exception, for over 15 years.  While there are various shapes and sizes, I don’t think it matters very much.

3.  I always pass the scleral buckle around the entire eye.  This reduces abnormal amounts of astigmatism which may develop with buckles placed in certain segments of the eye.  The amount of induced myopia is also easier to estimate as the same procedure is repeated time after time.

4.  By using the same buckle and encompassing the entire eye, I am able to complete the operation by minimizing variation and minimizing operating time.  My surgical team always knows what I am doing.

This increase in speed and efficiency translates to less surgical trauma to the eye, fewer chances of side effects and quicker recovery.


When to Call After Your Retinal Surgery

When to call your doctor after retinal surgery.  Randall Wong, MD.  I want my patients to call me after retinal eye surgery if they develop pain and/or  loss of vision.  These two symptoms can be signs of either infection or retinal detachment, the two most dreaded complications of retinal surgery .

Eye Infection Can Blind

The most concerning post-operative complication of retinal eye surgery would be infection inside the eye.  Infection inside the eye, called endophthalmitis, often leads to blindness.

The most frequent symptoms of endophthalmitis are pain and loss of vision.  (Unfortunately, these symptoms are not 100% so please call your own doctor if you are concerned.)

I tell my patients to call if they develop pain that is not relieved by Tylenol, Advil or whatever usually works for headache.  Incidentally, I rarely need to give an prescription pain relief for any of my surgeries.  An advantage of this is the ability to monitor pain.

Pain can develop for other reasons other than infection, say increased eye pressure, but potentially blinding eye infection is obviously the most concerning.

Fortunately, endophthalmitis is very, very uncommon in retinal surgery.

Signs of Retinal Detachment

Signs of retinal detachment following retinal surgery are not as obvious as compared to naturally occurring retinal detachments (I couldn’t think of a better term.)  The usual signs of retinal detachment are flashes, floaters and loss of peripheral vision.

After retinal surgery, vision is usually poor so that the normal signs may be missed.

My advice for may patients is that they call if the vision gets worse, in any way, compared to the first day when the patch comes off.

Compared to cataract surgery, retinal surgery usually does not restore the vision quickly, if at all.  I ask my patients to distinguish between actual worsening vision versus vision which fails to improve as quickly as hoped.

In general, if the vision improves or stays the same after the patch is removed…things are fine.

What Does This Mean?

These are my own recommendations for my patients.  While I feel these are very good guidelines and have worked well for my patients over the past 20+ years, please follow the directions and recommendations of your personal doctor.

I try to practice medicine as practically as possible.  My biggest fears following retinal surgery are infection and retinal detachment.  Your doctor may have other concerns or you may have a specific condition or situation where these recommendations don’t apply.


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

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



Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
View Map

Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
View Map