The high proportion of reoperations for recurrent retinal detachments could be significantly reduced with correct indication and execution of the first operation, according to retina specialist, Dr Borja Corcóstegui, the medical director of the IMO.
As Dr Corcóstegui explains, "about 50% of patients who undergo retinal detachment surgery require two, three or even four operations because of recurrent detachment, and this could be reduced by good initial surgery." The most appropriate technique to deal with this kind of retinal problem is scleral buckling, either on its own or in combination with vitrectomy.
The problem, however, is that, "on too many occasions, it is not carried out due to its high degree of difficulty, with the surgeon often electing to directly use vitrectomy." According to the retinologist, "this is often the reason why so many patients suffer various detachments after the first operation and require reoperation, usually with a poor prognosis."
Scleral buckling involves suturing silicone elements to the wall of the sclera (outer layer of the eyeball), where retinal detachments normally occur. During the procedure, the ocular muscles have to be dissected and held by threads, and the eye moved to suture the silicone piece. It is usually performed with retrobulbar anaesthesia and sedation, i.e. local anaesthesia as well as patient sedation.
Prior to the operation, a comprehensive and thorough eye examination is required, especially of the detached area, to identify all of the tears. The examination is performed with a binocular indirect ophthalmoscope and a three-mirror lens through a slit lamp. If all of the tears are correctly detected, scleral buckling has an excellent prognosis and precludes the need to work inside the eye as well.
Retinal detachment is an eye disorder caused by the spontaneous detachment of the neurosensory retina (inner layer of the retina) from the pigment epithelium (outer layer). When detachment occurs, fluid accumulates in the space left between the layers, and the detached retina cannot function or nourish itself properly. If left untreated, it can cause the eye to cease functioning (blindness).
Retinal detachment usually develops from tears caused by the vitreous gel, which fills the eyeball, exerting traction on a fragile area of the retina. It can also be caused by other disorders, such as diabetic retinopathy, high myopia, complications resulting from previous eye surgery, ocular trauma, tumours and severe inflammation. The most common symptoms include the appearance of floaters (black specks that move when the eye moves), flashes, a black veil across part of the visual field, image distortion and decreased visual acuity.
It is advisable for patients to undergo preventative laser treatment, if the retina has developed tears, but has not yet become detached. These patients and their families, who are also considered at risk, should visit their ophthalmologist at least once a year. We also share an article by ABC on the same subject.