Treatment for Retinal Detachment
Treatment for Retinal Detachment
Here are several methods available to treat a detached retina and all of these depend on finding and closing the retinal tears. These include:
Scleral buckling
Scleral buckling is a common treatment modality to fix a retinal detachment. The sclera (outer white part of the eye) is buckled (indented) by sewing silicone, rubber or a semi-hard plastic band to the surface of the eye. The band applies pressure onto the sclera in the area where the retina is detached from its underlying layers. The band works by pushing the sclera towards the middle of the eye so that the torn retina lies against the wall of the eye, counterbalancing any force that pulls the retina away from its place. The band is left in place permanently and is not noticeable after the surgery.
Sutureless Vitrectomy
Vitrectomy refers to the removal and replacement of the vitreous (clear gel that fills the back of the eye) with saline. In this procedure, the vitreous is removed so that the doctor can access the back of the eye. The retina is then treated by removing the scar tissue that is pulling the retina away from the underlying layers of tissue. Vitrectomy generally involves three small incisions in the sclera (outer white part of the eye). But with newer surgical techniques and instrumentation, the surgery can be performed through tiny 'self-sealing' incisions without the need for sutures; the procedure is therefore called a sutureless vitrectomy. This new technique uses special equipment that enables the surgeon to reach the vitreous using cuts that are very small that close automatically without requiring sutures. This procedure does not cause excess trauma, redness, watering and post-operative discomfort, all of which can occur with the conventional procedure. The overall time required for surgery is also less and the patient can resume his/her routine work earlier.
Tamponades
Retinal detachment usually requires surgery (vitrectomy) during which a tamponade agent is used. Tamponade is the material that is injected into the vitreous cavity (the cavity located behind the lens of the eye and in front of the retina) to hold the retina in place. A tamponade is often needed to reduce the rate of recurrent retinal detachment. Tamponades are various gases or silicone oils that not only hold the retina in place but temporarily seal the retinal tears. These tamponade agents help in the reattachment of the retina by reducing the rate at which the fluid flows between the retina and the underlying layers through open retinal tears. When gas is used, the body will reabsorb it, however, if silicone oil is used, this will need to be removed at a later date once healing has occurred.
Silicone oil
Silicone oil is one of the tamponade agents used during the surgery for retinal detachment. This tamponade is particularly useful when retinal traction (pulling on the retina) cannot be completely relieved and for patients who are unable to maintain the head positioning required for a gas tamponade of the retina. Advantages of silicone oil are that the patients can fly post-surgery unlike patients with a gas tamponade where flying should be avoided until the gas bubble has dissolved. Also, only minimal follow-up is required and the patient can see through the oil while the retina is being stabilized.
C3F8/SF6
C3F8 (Octafluoropropane) / SF6 (Sulfur hexafluoride) are gases that are commonly used as tamponade agents during surgery to repair a retinal detachment. The high surface tension between gas and fluid facilitates the effective closure of a retinal tear; and enables the retinal pigment epithelium (RPE: the layer below the retina) to absorb any fluid that remains in the subretinal space (the space between the retina and retinal pigment epithelium). This helps the reattachment of the detached retina.
