Services / Ophthalmological surgeries / Retinal surgery with an explant or a buckle

Retinal surgery with an explant or a buckle

GENERAL INFORMATION

Retinal surgery with an explant or a buckle is one of the methods of treating retinal detachment. Retinal detachment is a disease that leads to complete loss of vision. This is why surgical treatment should be carried out as soon as possible, preferably within the first three days of the detachment. Fast surgery is necessary due to the fact that the retina is nourished through the contact with the underlying choroidal layer. The longer it remains detached, the more malnourished it becomes. As a result, nerve elements lose their properties, and this leads to loss of vision.

Retinal detachment is almost always treated surgically.

There are two methods of surgical treatment of retinal detachment:

The decision which method is best for a particular patient is made by an ophthalmologist who specializes in retinal surgery – a vitreoretinal surgeon.

All surgeons operating on retinal detachments at the Retina Ophthalmological Outpatient Clinic and Hospital graduated from the European School of Vitreoretinal Surgery in Bremen (EVRS).

1. Scleral buckling – suturing an explant or a buckle to the sclera

The surgery involves suturing a silicone supporting buckle or a special explant (made of sponge or silicone) to the outer wall of the eye – the sclera.

The goal of the procedure is to indent (push inward) the outer wall of the eyeball – the sclera, which is why this procedure is also called an episcleral surgery or indentation.

Suturing an explant or a buckle to the sclera allows the eyewall to be brought closer to the detached retina. This allows the subretinal fluid to be absorbed from underneath the retina and prevents further fluid penetration through the retinal hole/opening.

The force with which the explant indents the eye wall reduces the vitreoretinal tractions, and the retina gets closer to the eyewall.

During the procedure, the surgeon also performs laser therapy or cryotherapy around the tears and holes. This way he creates a permanent scar that “glues” the retina back in place and protects the damaged area.

The procedure can be combined with the injection of a special gas bubble into the eyeball to fill it and further press the retina against the eye wall for several days after surgery.

Episcleral surgery is performed at the Retina in compliance with the highest standards and sterility, as a same-day outpatient surgery, under combined anesthesia.

In some patients, the procedure is performed in conjunction with other surgeries, such as vitrectomy or cataract removal.

2. Vitrectomy

3. The surgery involves removing the vitreous body, the gel the gel-like substance that fills the inside of the eye. Find out more about this surgery here.

PRACTICAL INFORMATION

Before a retinal surgery with an explant or a buckle it is necessary to undergo a pre-assessment at the Retina Ophthalmological Outpatient Clinic and Hospital. During the visit we will take your medical history, perform full ophthalmological exam and the necessary diagnostic tests.

Kalkulator MediRaty

Can retinal detachment be cured completely?

Current surgical techniques allow reattachment of the retina in about 90% of cases. Unfortunately, even after a successful surgery, not all patients regain visual acuity. As a result of retinal detachment, some people develop irreversible changes in the photoreceptors and neurons that connect the different layers of the retina. This happens especially in patients with macula-off retinal detachment. These are patients whose retinal detachment involved also the macula, which is the area in the retina that is responsible for the best quality of vision.

Quality of vision after the surgery may also be poor in patients whose retinal detachment lasted more than three days.

It must be remembered that post-surgical improvement is a gradual process and it can continue for many months after the surgery. Similar to patients after a stroke, the completion of the recovery processes takes two years. This is because the retina is the only extension of the brain that can be viewed from the outside.

Potential complications associated with retinal detachment surgery

The risk of complications is low – about 10%. It should be remembered that surgery for retinal detachment is necessary if the patient wants to retain their vision, and must be performed within the first three days after the onset of detachment.

Potential post-operative complications include:

recurrence of retinal detachment,
proliferative vitreoretinopathy, which is an abnormal process involving forming of cellular membranes in the vitreous and on both sides of the retina. The membranes develop up to 3 months after surgery and can shrink, which again detaches the retina. The occurrence of proliferative vitreoretinopathy requires a surgery, as the membranes must be removed from the surface and from beneath the surface of the retina,
anterior segment ischemia,
choroidal detachment,
bacterial endophthalmitis,
diplopia,
cystoid macular edema,
decreased or elevated intraocular pressure,
changes in vision that persist for up to six months after surgery,
cataract, i.e. clouding of the naturally transparent lens,
eyelid drooping.

Pre-operative recommendations

on the day of the surgery, you should report to the Clinic wearing comfortable clothes (e,g. a tracksuit); you will be given a disposable patient bodysuit
on the day of the surgery do not put on facial or eye makeup,
prescribed chronic-use medications should be taken at the usual time, except the ones listed below,
3-7 days before the surgery patients should discontinue blood thinners, such as: Acard, Aspiryna, Aspro C, Asprocol, Polopiryna, Rhonal, Ring N, Solucytel, Thomapyrin, Pradaxa, Xarelto, Plavix, Warfin, Acenokumarol.

Prior to the scheduled surgery you will be provided with additional detailed information.

What to expect during retinal surgery with an explant or a buckle

The entire procedure takes between one and two hours. The patient is discharged after they have rested for about an hour.

Retinal surgery with an explant or a buckle is performed under combined anesthesia (local anesthesia with sedation). This means cooperation between an anesthesiologist, who administers intravenous sedatives and painkillers, and an ophthalmologist, who administers local anesthesia to the eye.

After the surgery the patient usually does not feel pain. Sometimes they may feel slight stinging or a gritty sensation, which can be relieved with over-the-counter painkillers.

Important after retinal surgery with an explant or a buckle

After the procedure the patient should not use public transport, and should be escorted home by an adult companion.
For 24 hours after anesthesia the patient cannot drive, operate dangerous equipment or drink alcohol.
After the surgery the face should not be immersed in water and the eye should be kept dry, as this can lead to infection. For 3 weeks caution should be exercised when bathing, until the wound becomes watertight.
For 2-3 weeks after the surgery patients should abstain from doing work that requires a lot of physical effort (e,g. moving heavy furniture or lifting over 15 kilograms).
On sunny days patients should wear sunglasses.
The dressing remains on the patient’s eye until the first follow-up visit, which takes place the day after the procedure. Then next follow-up visits are scheduled.
Ophthalmic drops should be used according to the regime specified in the treatment information sheet.

After the surgery the patient receives a set of detailed information and instructions from our staff.