What are the most commonly used surgical intervention for retinal detachment?

This review included 10 RCTs (1307 eyes of 1307 participants) from Europe, India, Iran, Japan and Mexico, which compared PPV and scleral buckling for RRD repair. Two of these 10 studies compared PPV combined with scleral buckling with scleral buckling alone (54 participants). All studies were high or unclear risk of bias on at least one domain. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.

There was little or no difference in the proportion of participants who achieved retinal reattachment at least 3 months after the operation in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16; 9 RCTs, 1261 participants, low-certainty evidence). Approximately 67 in every 100 people treated with scleral buckling had retinal reattachment by 3 to 12 months. Treatment with PPV may result in 4 more people with retinal reattachment in every 100 people treated (95% confidence interval (CI) 2 fewer to 11 more).

There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10, 6 RCTs, 1138 participants, low-certainty evidence).

There was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR 1.01, 95% CI 0.99 to 1.04, 9 RCTs, 1235 participants, low-certainty evidence). There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.

Retinal redetachment was reported in fewer participants in the PPV group compared to the scleral buckling group (RR 0.75 (95% CI 0.59 to 0.96, 9 RCTs, 1320 participants, low-certainty evidence). Approximately 28 in every 100 people treated with scleral buckling had retinal detachment by 3 to 36 months. Treatment with PPV may result in seven fewer people with retinal detachment in every 100 people treated (95% CI 1 to 11 fewer).

Participants treated with PPV on average needed fewer interventions to achieve final anatomical success but the difference was small and data were skewed (MD -0.20, 95% CI -0.34 to -0.06, 2 RCTs, 682 participants, very low-certainty evidence).

Very low-certainty evidence on quality of life suggested that more people in the PPV group were "satisfied with vision" compared with the scleral buckling group (RR 6.22, 95% CI 0.88 to 44.09, 1 RCT, 32 participants).

All included studies reported adverse effects, however, it was not always clear whether they were reported as number of participants or number of adverse effects. Cataract development or progression was more prevalent in the PPV group (RR 1.71, 95% CI 1.45 to 2.01), choroidal detachment was more prevalent in the scleral buckling group (RR 0.19, 95% CI 0.06 to 0.65) and new/iatrogenic breaks were observed only in the PPV group (RR 8.21, 95% CI 1.91 to 35.21). Estimates of the relative frequency of other adverse effects, including postoperative proliferative vitreoretinopathy, postoperative increase in intraocular pressure, development of cystoid macular oedema, macular pucker and strabismus were imprecise. Evidence for adverse effects was low-certainty evidence.

Scleral buckling; Vitrectomy; Pneumatic retinopexy; Laser retinopexy; Rhegmatogenous retinal detachment repair

Retinal detachment repair is eye surgery to place a retina back into its normal position. The retina is the light-sensitive tissue in the back of the eye. Detachment means that it has pulled away from the layers of tissue around it.

This article describes the repair of rhegmatogenous retinal detachments. These occur due to a hole or tear in the retina.

As a result of injury, tumors, or disease, the retina can become completely or partially detached causing diminished vision. The retina can be repaired by laser, cryoprobe, or surgery.

The retina is the internal layer of the eye that receives and transmits images that have passed through and been focused by the lens and cornea.

Most retinal detachment repair operations are urgent. If holes or tears in the retina are found before the retina detaches, the eye doctor can close the holes using a laser. This procedure is most often done in the health care provider's office.

If the retina has just started to detach, a procedure called pneumatic retinopexy may be done to repair it.

Pneumatic retinopexy (gas bubble placement) is most often an office procedure.
The eye doctor injects a bubble of gas into the eye.
You are then positioned so the gas bubble floats up against the hole in the retina and pushes it back into place.
The doctor will use a laser to permanently seal the hole.

Severe detachments need more advanced surgery. The following procedures are done in a hospital or outpatient surgery center:

The scleral buckle method indents the wall of the eye inward so that it meets the hole in the retina. Scleral buckling can be done using numbing medicine while you are awake (local anesthesia) or when you are asleep and pain free (general anesthesia).
The vitrectomy procedure uses very small devices inside the eye to release tension on the retina. This allows the retina to move back into its proper position. Most vitrectomies are done with numbing medicine while you are awake.

In complex cases, both procedures may be done at the same time.

Retinal detachments DO NOT get better without treatment. Repair is needed to prevent permanent vision loss.

How quickly the surgery needs to be done depends on the location and extent of the detachment. If possible, the surgery should be done the same day if the detachment has not affected the central vision area (the macula). This can help prevent further detachment of the retina. It also will increase the chance of preserving good vision.

If the macula detaches, it is too late to restore normal vision. Surgery can still be done to prevent total blindness. In these cases, eye doctors can wait a week to 10 days to schedule surgery.

Risks for retinal detachment surgery include:

Bleeding
Detachment that is not completely fixed (may require more surgeries)
Increase in eye pressure (elevated intraocular pressure)
Infection

General anesthesia may be needed. The risks for any anesthesia are:

Reactions to medicines
Problems breathing

You may not recover full vision.

The chances of successful reattachment of the retina depend on the number of holes, their size, and whether there is scar tissue in the area.

In most cases, the procedures do not require an overnight hospital stay. You may need to limit your physical activity for some time.

If the retina is repaired using the gas bubble procedure, you need to keep your head face down or turned to one side for several days or weeks. It is important to maintain this position so the gas bubble pushes the retina into place.

People with a gas bubble in the eye may not fly or go to high altitudes until the gas bubble dissolves. This most often happens within a few weeks.

Most of the time, the retina can be reattached with one operation. However, some people will need several surgeries. More than 9 out of 10 detachments can be repaired. Failure to repair the retina always results in loss of vision to some degree.

When a detachment occurs, the photoreceptors (rods and cones) start to degenerate. The sooner the detachment is repaired, the sooner the rods and cones will begin to recover. However, once the retina has detached, the photoreceptors may never recover completely.

After surgery, the quality of vision depends on where the detachment occurred, and the cause:

If the central area of vision (macula) was not involved, vision will usually be very good.
If the macula was involved for less than 1 week, vision will usually be improved, but not to 20/20 (normal).
If the macula was detached for a long time, some vision will return, but it will be very impaired. Often, it will be less than 20/200, the limit for legal blindness.

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Guluma K, Lee JE. Ophthalmology. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 61.

Todorich B, Faia LJ, Williams GA. Scleral buckling surgery. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 6.11.

Wickham L, Aylward GW. Optimal procedures for retinal detachment repair. In: Schachat AP, Sadda SVR, Hinton DR, Wilkinson CP, Wiedemann P, eds. Ryan's Retina. 6th ed. Philadelphia, PA: Elsevier; 2018:chap 109.

Last reviewed on: 8/18/2020

Reviewed by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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