Vitrectomy combined with scleral buckle is the last way to repair a retinal detachment. This combines two separate methods to repair a retinal detachment. Both vitrectomy and scleral buckle can be used alone to fix a retinal detachment.
Retinal detachments occur because the vitreous has caused a tear in the retina. In addition, the vitreous may also be pulling on the retina to cause it to “tent” or detach.
You Are the Vitreous
Let’s pretend you are in the middle of a room with outstretched arms. The room is the eye and wallpaper is the retina. You are the vitreous. Lastly, imagine long, taut pieces of tape extend from the tips of your fingers with the other ends on the wall paper.
If you lean to the left, you’ll pull and cause a tear in the wallpaper attached to your right hand. If you move to the right, the opposite will happen, you’ll cause a tear to the left.
Scleral Buckle for Retinal Detachment
Whether the scleral buckle goes completely around the eye or is partially installed around the eye does not matter. Whatever element is used to create the “buckling” effect of the eye, the result is to induce slack in the vitreous by reducing the internal diameter of the eye.
In our example, we are moving the walls of the room closer together. This causes the tape to slacken. Now, you can lean left or right without tearing the wallpaper due to the slack. Whatever forces there were pulling on the retina, they have been relieved.
Vitrectomy for Retinal Detachment
Vitrectomy is an intraocular operation where the vitreous is cut away. Remember, it’s the vitreous which causes tears and exerts a pulling force to elevate and detach the retina.
It makes sense to cut away the vitreous which is pulling on the retina. Returning to our example, if we simply cut the tape, leaning left or right would not cause pulling on the wall paper.
This is the value of vitrectomy. It removes the forces of the vitreous pulling on the retina to cause tears and detachment.
After the vitrectomy is completed, it is customary to fill the eye with gas. With proper head positioning, the gas should prevent redetachment by “plugging” the tears causing the retinal detachment. The gas doesn’t really push on the retina to reattach.
What Does this Mean?
The best operation to reattach the retina from a statistical standpoint is to perform a vitrectomy with a scleral buckle. It is the most complicated surgery. With difficult surgery, however, the complications can increase.
This is probably why most surgeons do not always perform both procedures for all retinal detachments. The more difficult the surgery, the more chance of complications.
Over the years, I have developed my algorithms, or practice, for certain types of retinal detachments. In my experience, certain retinal detachments warrant longer and more complicated surgery, but probably yielding better outcomes than if we attempted different procedures.
Maybe this is called experience.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
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