Urgency of Retinal Detachment Surgery

written by Dr Kenneth Fong Choong Sian on 31 March 2013
Urgency of Retinal Detachment Surgery
Retinal detachment is a sudden and unexpected condition that can happen to anyone. The retina which is the thin nerve layer at the back of your eye, separates from the rest of the eye due to a hole in the retinal layer. People who are short-sighted (myopic) are at higher risk of retinal detachment.
Symptoms of retinal detachment include floaters, flashing lights, shadows in the corner of your vision, and loss of vision. Initially, you will notice blurring of vision in the corner of your vision as the retinal detachment usually starts in the corner of your eye. As the retinal detachment gets worse, it will reach the macula which is the centre of the retina and is the most important part of the retina. When this happens, you will lose all your eyesight.
How soon should retinal detachment surgery be done?
Retinal detachment is one of the few eye emergencies and once it is diagnosed, surgery needs to be done as soon as possible to save the eye sight. Eye doctors use terms called “macula- on ” or “macula – off” when describing retinal detachments. This is because when the macula is still “on” or not detached, the more urgent the need for surgery is. The patient can still see well in the centre but their peripheral vision is poor. If I see a patient with a retinal detachment that has not yet affected the macula, I would try to perform surgery as soon as possible. This may mean surgery after working hours or on weekends. This is because, every minute counts in this type of retinal detachment and early treatment will allow the patient to regain almost all their vision.
For “macula-off” retinal detachment, the situation is not as urgent even though the patient has lost most of their eyesight. Surgery can be done within the next few days at a time convenient for both the doctor and the patient. Many studies have been done to look at the best time for such retinal detachments and have shown that outcomes after “macula off” retinal detachment surgery when done within 1 week of loss of vision are very good.
Who should perform retinal detachment surgery?
If you do have a retinal detachment, it is important that you have a well-trained retinal surgeon to fix your eye problem. This is because the first attempt to repair the retinal detachment is the best chance to fix it. For surgery for retinal detachment, I have to decide whether to perform a scleral buckle or vitrectomy operation and whether to put in gas or silicone oil into the eye. If the first operation fails and the retinal detachment recurs, it is harder to repair the eye and save the eyesight with further surgery. Success rates of retinal detachment surgery with the one operation are about 90% but in 10% of cases, the retinal detachment may still come back and further surgery is needed. This happens to the best of surgeons and there is no retinal surgeon that can claim a 100% success rate in repairing retinal detachments with one operation.
In summary, if you do have symptoms of retinal detachment, you need to have an urgent retinal examination with a qualified eye doctor. They will then confirm the diagnosis and may refer you on to their preferred retinal surgeon colleague for further treatment, if they are not trained in retinal surgery. Retinal detachment is a frightening condition to have but in most cases, we are able to save the eye sight of most of our patients that come to us in time.