Retinal detachment repair is an emergency medical procedure used to treat separation of the retina from the choroid. When the retina develops tears due to trauma, aging, or pathological changes, and vitreous fluid infiltrates beneath the retina, the retina gradually detaches, which can lead to permanent vision loss if severe. The primary goal of this treatment is to immediately seal the retinal tears, restore the attachment between the retina and choroid, and prevent further deterioration of vision.
The surgery is usually performed within 24 to 72 hours after diagnosis to improve the success rate. Retinal detachment is classified into exudative, rhegmatogenous, and tractional types, with treatment methods tailored according to the cause and extent of detachment. Timely treatment not only saves vision but also reduces the risk of subsequent complications.
Retinal detachment repair includes various surgical techniques, primarily aiming to seal tears, drain subretinal fluid, and reattach the retina. Common procedures include:
The surgery may involve gas tamponade or silicone oil injection, using gas bubbles or silicone oil to press against the retinal tears, often combined with specific head positioning to facilitate the retina's recovery to normal anatomical structure.
This treatment is suitable for retinal tears, partial or full-thickness detachments, and retinal changes caused by diabetic retinopathy, high myopia, or trauma. If the detachment extends to the macula or causes a sudden decrease in vision, immediate surgery is required.
The following conditions warrant consideration of this treatment:
The surgery is typically performed under local or general anesthesia, with outpatient or inpatient treatment depending on the condition. Vitrectomy involves removing the vitreous and injecting gas or silicone oil; postoperatively, patients must maintain specific head positions (such as face-down) for several days to ensure the gas bubble or silicone oil exerts pressure on the tear.
Patients with silicone oil require a second surgery to remove it after 6 to 12 months, while those with gas tamponade should avoid flying or high-altitude activities to prevent gas expansion and increased intraocular pressure. The procedure lasts about 1 to 3 hours, with specific steps adjusted based on the extent of detachment.
The key advantages of this treatment include:
Modern surgeries combine laser photocoagulation and vitrectomy to handle complex cases such as tractional retinal detachment. Silicone oil or gas tamponade techniques can maintain long-term retinal attachment and reduce the risk of re-detachment.
Potential risks and side effects include:
Short-term risks include corneal haze or damage to corneal endothelial cells, while long-term complications may involve recurrent retinal detachment or subretinal fluid accumulation. Patients must strictly adhere to postoperative head positioning; non-compliance may lead to surgical failure.
Contraindications include severe cardiopulmonary diseases, uncontrolled diabetes with ketoacidosis, or severe ocular structural damage that cannot be repaired. Preoperative assessment of general anesthesia risks is necessary. Patients with glaucoma or cataracts may require adjusted surgical strategies.
Postoperative precautions include:
If patients are on anticoagulants (such as warfarin or novel oral anticoagulants), dosage adjustments are necessary preoperatively to reduce bleeding risk. When combined with cataract surgery, coordination of surgical sequence and anesthesia mode is required.
Use with anti-VEGF drugs should be cautious, as some medications may affect retinal healing. Diabetic patients should control blood glucose levels to optimize surgical outcomes.
Statistics show initial surgical success rates of approximately 85-90%, though complex cases may require secondary surgeries. Follow-up studies indicate the best prognosis in cases where the macula is unaffected, with visual recovery rates exceeding 70%. Gas tamponade achieves a retinal reattachment rate of up to 95%, though silicone oil-related complications may impact long-term results.
Multicenter studies confirm that combining laser photocoagulation with vitrectomy reduces re-detachment rates. Long-term follow-up shows that 80% of patients experience at least two lines of visual improvement within 6 months postoperatively.
Early mild cases may consider non-surgical treatments such as laser photocoagulation or cryopexy to seal small tears. However, if the retina is fully detached or traction is severe, surgery remains the only effective option.
Conservative treatments like intraocular pressure control or anti-VEGF injections are only suitable for specific complications and cannot replace primary repair surgery. Patients with severe systemic diseases may require staged treatments.
What preparations are needed before surgery? What should be paid attention to on the day of surgery?
Before surgery, a detailed eye examination including retinal imaging or OCT is necessary to confirm the extent of detachment. Patients should stop anticoagulants (such as aspirin) and arrange transportation on the day of surgery, as anesthesia may impair judgment. Fasting for 6 hours prior to surgery and following medical instructions regarding local or general anesthesia are required.
Is it necessary to maintain a specific head position after surgery? How long should this be continued?
Some procedures (such as silicone buckle surgery) may require patients to maintain a specific head position for 1-2 weeks to facilitate retinal and pigment epithelium reattachment. The doctor will advise based on the surgical method and detachment location. Strict adherence to instructions is essential to improve success rates.
Are light spots or flashes normal after surgery? Should I seek immediate medical attention?
Minor light spots may be normal during retinal repair, but if new large flashes or sudden vision loss or visual field defects occur, they may indicate recurrent retinal detachment and should be examined immediately.
How long after surgery can I resume normal activities? When can I return to sports or travel abroad?
Generally, rest for 1-2 weeks, avoiding heavy lifting or vigorous activities to prevent retinal displacement. High-altitude flights or diving should be avoided within 3 months due to pressure changes affecting the silicone bubble. Recovery time varies depending on the type of surgery and healing progress; follow your doctor’s instructions.
Can vision fully recover after surgery? What are the possible reasons for treatment failure?
Visual recovery depends on the duration and extent of detachment. If the macula remains unaffected and treatment is timely, success rates can reach 80-90%. Causes of failure include severe retinal tissue damage, fibrous proliferation pulling the retina, or non-compliance with head positioning. Regular follow-up is necessary for early detection of complications.
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