Retinal detachments can be treated. Surgery is usually successful in reattaching the retina in one operation in 9 out of 10 patients. However this means that further surgery is occasionally required in some patients. There are 3 ways of treating retinal detachments. The appropriate technique used depends on the features of the retinal detachment and age of the patient:

Scleral buckle: This surgical procedure has been in use for more than 30 years, and, until approximately 20 years ago, was the only procedure available. It is still commonly used for rhegmatogenous retinal detachments, especially when there are no complicating factors. The procedure involves localizing the position of all the retinal breaks, treating all retinal breaks with the cryoprobe and supporting all the retinal breaks with a scleral buckle. The buckle is usually a piece of silicone sponge or solid silicone. The type and shape of the buckle varies depending on the location and number of retinal breaks. The buckle is sewn onto the outer wall of the eyeball (sclera) to create an indentation or buckle effect inside the eye. The buckle is positioned so that it pushes in on the retinal break and effectively closes the break. Once the break is closed, the fluid under the retina (subretinal fluid) will usually spontaneously resolve over 1-2 days. Sometimes the surgeon elects to drain the subretinal fluid at the time of surgery. Most often, a scleral buckle procedure can be done with local anesthesia and as same day surgery ( in and out of the hospital on the same day). Postoperatively, there are usually no positioning requirements and one can resume most activities within several days (except for anything that would jar the head).

Vitrectomy: Usually referred to as a trans pars plana vitrectomy (TPPV), this procedure was first used ~ 20 years ago and has been continuously refined and improved since then. It is most commonly used for traction retinal detachments from diabetes but is also used for rhegmatogenous detachments especially if they are associated with vitreous traction or vitreous hemorrhage. The procedure involves making small incisions into the wall of the eye to allow the introduction of instruments into the vitreous cavity (the middle of the eyeball). The first part of the procedure usually is the removal of the vitreous using a vitreous cutter. Then, depending on the type and cause of the detachment, a variety of instruments (scissors, forceps, pics, lasers, etc…) and techniques (excision of tractional bands, air-fluid exchange, silicone oil fill, etc…) are used to reattach the retina. A TPPV can also usually be done as same day surgery and with local anesthesia. It is sometimes important to maintain a specific head position after surgery to keep the retina attached. More information regarding vitrectomy surgery can be found on the

Pneumatic retinopexy: Over the past 10 years, this has become a popular way to repair a straight-forward rhegmatogenous retinal detachment, especially if there is a single break located in the superior portion of the retina. This procedure involves injecting a gas bubble into the middle part of the eye (vitreous cavity). It is then critical to position oneself so that the gas bubble covers the retinal break. If the break can be covered by the bubble, the subretinal fluid will usually resolve within 1-2 days. The retinal tear is either treated with cryopexy before the bubble is injected or with laser after the retina has flattened. The main advantages of this approach are that it can be done in the office, thus avoiding hospitalization and that it avoids some of the complications of scleral buckling surgery, although it has its own set of complications. The main disadvantages are the requirement for precise head positioning for up to 7-10 days following the procedure and a slightly lower initial success rate as compared to a scleral buckle. If the retina is not reattached by a pneumatic retinopexy procedure, a scleral buckle and/or TPPV can be done at that point.