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Retinal Detachment Surgery
January 19, 2012 By Randall Wong, M.D.

 

This is my latest recording of surgery for a retinal detachment.

This is the second of (what I hope) to be a series of “videos” on the surgical aspects of retinal eye disease.  This is a recording of two procedures often combined to repair, or fix, a retinal detachment.

Anesthesia

Now, this video is quite graphic.  Believe it or not, however, the patient is completely comfortable…as it does not hurt.  I generally favor this procedure be done with a retrobulbar block (this is an injection behind they eye that “blocks” all pain conduction) in addition to very light sedation for this eye surgery.

On occasion general anesthesia is preferred.

The Scleral Buckle

The scleral buckle is passed around the outside of the eye and underneath each of the 4 four rectus muscles.  I sew the buckle to the eye using some thin suture material.  In the video, the suture is white in color.

There are various techniques to pass the buckle around the eye and innumerable varieties of buckles from which to choose.  I have used the same, small thin buckle almost exclusively for the last 10 years.  I do not think the size or thickness of the buckle, nor its material, is important.

I prefer to always go completely around the eye.  Some choose to place the buckles in different orientations and configurations.  Again, I don’t think this is important.

Efficiency of Surgery

By repeating the same techniques over and over, my surgical team can easily anticipate my each and every move.  They can be sure to accurately predict the correct instruments and materials I’ll need for each part of the case.

In this way, we have developed a very efficient surgical model for our patients.  From the technical aspect, we are quite competent having done this time and time again.  From the patients perspective, there is less surgical trauma and reduced time under anesthesia.

I believe that the more efficient a team, the less likely complications may occur due to reduced operating time and increased experience of the team.

Vitrectomy for Retinal Detachment

After the scleral buckle is placed, I then go inside the eye and repair the retinal detachment from the inside by performing a vitrectomy.  This “3 port” system is not unlike arthroscopic surgery or laparoscopic surgery…all “closed” systems.

The goal of the vitrectomy is to remove the stressers on the retina by removing the vitreous.  I can also remove the fluid from within the vitreous cavity (where fluid is normally located) and underneath the retina (abnormally located fluid.)

Intraocular gas used to temporally keep the retina reattached while appropriate scarring takes place.  The scarring is induced usually by use of the laser.  The goal of the laser is to “spot weld” around each and every tear and hole in the retina.

What Does This Mean?

The scleral buckle has been around for generations.  It remains a mainstay of treatment due to its success in repairing retinal detachments.

The modern day vitrectomy has been around for only 30 years, while the present 25 gauge systems have been around less than 10.

My estimation is that a scleral buckle alone or vitrectomy surgery alone is about 90% successful in reattaching the retina.  Used in combination, I believe that “success” is somewhere around 95%.

This has now become a highly effective surgery combining both “old” and “new” techniques.  Both can usually be performed in an outpatient setting under similar settings.  As these techniques become more common place, they are therefore more available to everyone.

 

Comments
  • Elizabeth January 23, 2012 at 6:37 pm

    This amazing and so are you.

  • floateredeyes January 29, 2012 at 9:12 pm

    Dear Dr. Wong,
    Would you be kind enough to also post a video of a PPV done on one of your floater patients? It will be a nice learning tool for all of us, even though it wont be much different from vitrectomies done for other indications. Maybe watching how you induce PVD would be nice. Moreover, if the video was of surgery done on patient with lattice, that would be even more educational for all of us out there.

    I have asked for a lot, but hopefully you will think about it and see some value in my requests (and hopefully of many others out there).
    Regards,

    • Randall V. Wong, M.D. February 1, 2012 at 11:51 am

      Dear Floateredeyes,

      Yes. Forthcoming. I have one ready, but not with lattice. Also, I don’t favor inducing a PVD. Keep on the alert!

      Randy

  • Roberto February 16, 2012 at 2:07 pm

    VERY COOL. Great information and demonstration!

  • jami lydia rahardjo February 26, 2012 at 10:56 am

    It is really great educational website.
    I am a patient who is suggested to have combination of scleral bucle and vitrectomy surgery next week.
    Your information that the combination of the surgery is higher (95%) than each surgery (90%)
    convince me. God bless you doc…

  • Fred Wells February 29, 2012 at 10:50 am

    Dear Dr. Wong,
    I was diagnosed by my ophthalmologist as having a hole in my retina. I have a central area in my left eye that is dim. I have uvitus and have had surgery on my right eye. I’m told that I need surgery ASAP, so what’s the latest method of repairing the retina? I know the viterus fluid has to be removed, but would the retina repair surgery be done with a laser or a scapel? Thanks!

    • Randall V. Wong, M.D. March 6, 2012 at 9:33 am

      Dear Fred,

      I am wondering if you have macular edema from uveitis. This can lead to a macular hole.

      There are other macular holes, they look identical, not related to macular edema.

      In either case, surgery is indicated. This would be manual, not laser.

      Good luck,

      r

  • Chris March 12, 2012 at 11:56 am

    Dr. Wong,

    I had scleral buckle surgery with a gas bubble on Feb. 22. My Doctor says everything is healing great and that I may resume physical activities. I was wondering would playing basketball again this soon after surgery be okay from your professional opinion? I will probably wait another couple of weeks unitl my vision is better anyway. I’m a little scared to get back out there because I don’t want to have to go through this again.

    Thanks,
    Chris

    • Randall V. Wong, M.D. March 19, 2012 at 12:47 pm

      Dear Chris,

      Not sure basketball had anything to do with the detachment. Why are you concerned?

      Randy

  • Joel March 14, 2012 at 10:05 am

    Dear Dr. Wong,
    I would like your thoughts on using the scleral buckle as a preventative measure.

    A little history. I am 38 years old. I had a successful retinal detachment surgery via buckle, vitrectomy, and gas last August for my left eye. Now, my doctor is recommending that I have buckle with cryo surgery to repair a retinal hole in my right eye. The tear has been there for sometime as it has been walled off naturally. I am just not looking forward to another trip to the OR. Thoughts?

    • Randall V. Wong, M.D. March 19, 2012 at 12:27 pm

      Dear Joel,

      The literature recommends prophylactic scleral buckle and laser for a condition call “Giant Retinal Tear.”

      This does not seem to be your exact case, but the risk of retinal detachment in the right eye is higher due to the retinal hole. I think it’s a good idea to move forward with the cryo.

      I don’t know if a buckle and/or vitrectomy needs to be considered.

      Randy

  • cheri March 23, 2012 at 6:38 pm

    Dear Doctor Randy, In your opinion should silicone oil be used on a patient that has had a previous cataract surgeryI and had a silicone lens placed? I know the oil will attatch to the lens and could cause the lens to have to be taken out.

    • Randall V. Wong, M.D. April 4, 2012 at 7:20 am

      Dear Cheri,

      I just answered this on the other post…..but the short answer is yes, I don’t think oil on the lens competes with the importance of getting the retina attached.

      Randy

  • cheri March 23, 2012 at 6:46 pm

    I had this done and now have very poor vision in that eye. There are probrably 40-50 different size bubbles in my vison and vision is very blurry. The doctor was aware of the cataract implant but didn’t ask what type of lens until after the surgery oil attatclhed to the lens and behind lens. He tried to remove oil with surgery but was unable to get all of the oil out.. The doctor said I can have another surgery if it bothers me. At this ;point and time the bubbles make me dizzy when I am ambulating. My vision is terrible. I have to wear a patch at all times to just be able to see.

    • Randall V. Wong, M.D. April 4, 2012 at 7:22 am

      Dear Cheri,

      From what you say, sounds like the oil remnants are indeed problematic. I had to wear a patch for awhile and understand how “relaxing” it can be.

      We spoke about meeting in another post. I would be honored to meet you. If however, we don’t….I would suggest a second opinion from another retina specialist specifically asking that person if the oil/lens combo is indeed impacting your vision.

      Randy

  • cheri lemay April 4, 2012 at 12:49 am

    I love this site. It has helped me so very much. I have had a total of approx. 10 surgeries of which 2 were for catarcts in 2003. The rest have been for retinal detatchments and complications I had after surgery that brought on more surgeries. I had very little knowledge of the retina and had no idea so many people had this problem. It somehow makes me feel better to know that I am not the lone ranger to this horrific problem. Thank you so very much for sharing your knowledge. I am truly considering making an appointment to see you for a problem with right eye that has not been resolved. I live in ohio but it would be worth the trip to get some peace of mind. Thank you again for sharing.

    • Randall V. Wong, M.D. April 4, 2012 at 7:05 am

      Dear Cheri,

      Reading your post here and those you left on FB.

      1. “Comment Awaiting Moderation” means that the webmaster (yours truly) must approve every comment made from a new contributor. This protects the website from ridiculous comments or inappropriate material, etc. More importantly, it prevents spammers from posting non-sense comments, BUT including a link back to their spam site, aka, “Comment Spam.”)

      Basically, I have to read each post before it’s published. I try and answer on twice a week.

      2. Making an appointment is easy…just call and ask to see me.

      3. Thanks for your kind comments regarding the site. I am pretty proud of the past few years and how this has evolved!

      Look forward to meeting you.

      Randy

  • Eric April 8, 2012 at 10:46 am

    Dr. Wong,

    I am 10 days post op from scleral buckle surgery used as a preventative measure to prevent retina detachment. I lost vision in my right eye at a young age due to ROP and recently had a tear in my left eye that was repaired with laser, however due to my situation (high myopic and lattice in left eye), my doctor recommended the buckle. My retina doc is pleased with the outcome thus far and has stated that the vitreous is no longer pulling on my retina (no traction) as a result of the placement of the buckle. The only issue that I’m having so far is that I seem to be light sensitive and still notice light flashes on occassion, particulalrly when I’ve been in a well lit room and then walk in to a dark room or if I close my eyes sitting in a well it room. It’s different than what I saw before in terms of light flashes that were attributed to the tear diagnosis. This seems to be more like light reflection thwn just a simple “flash”. I wonder if the inflammation due to the surgery is causing this, medicine (pred forte and vigamox) or light sensitivity. I’ve been following up so far once a week and have mentioned this to my retina doctor, but he notes that all looks good in the eye. His words were “we are winning the battle”. I’m definitely encouraged by the news, but still concerned about the other factors present.

    I’ve heard some note that due to the buckle itself, flashes or light reflection is sometimes normal? Any information you can provide would be helpful. Also, how much protection does the buckle offer in terms of future eye health in my case. Thanks so much and Happy Easter!

  • Eric April 9, 2012 at 7:23 pm

    one more thing in regards to flashes, they are like the light from a copy machine and they are located where I have the most redness from surgery in lower corner of the eye near my nose. I can almost feel the sensation when they happen at times…like nerves endings. With no pulling on retina indicated by my retina doc, im just at a loss

  • Liesel Meier April 10, 2012 at 12:05 pm

    On 1/3/12 I had a scleral buckle placed due to retinal detachment from 3 o’clock to 6 o”clock position. No bubble. I had lots of pain weeks after surgery and total double vision. I was referred to a muscle specialist for surgery to correct hypotropia with restriction of the left inferior rectus muscle on 2/3/12. At that surgery the inferior rectus muscle was adjusted and adhesions and scar tissue between the scleral buckle and muscle were dissected. That surgery did not have a positive outcome. To this day (4/10) the double vision is worse than before. They now want to do another muscle surgery and at the same operation remove the buckle. I have not agreed to that operation yet. I would like to go some place else for a second opinion.
    My question is: If I would just have the buckle removed, would that improve the double vision. I am worried that the muscle surgery, which I now believe was premature, will also have to be addressed. Secondly, would it be better to have each operation done separately or in one operation?
    Would you have any suggestions for me. I live in Michigan.
    Thank you for your response

    • Randall V. Wong, M.D. April 17, 2012 at 10:01 pm

      Dear Liesel,

      I would encourage a second opinion. I have been doing this for 20 years. There is something amiss here.

      I would recommend seeking the opinion of another pediatric ophthalmologist (they deal with adult misalignment).

      All the best.

      Randy

  • RobK April 18, 2012 at 2:09 pm

    I had a detached retina in my right eye on 10/14/10 at age 46. It was repaired by gas bubble, vitrectomy, and lots and lots of lasering (over 4,500 shots). My MDs feel a buckle is necessary only AFTER these measures fail. Thank goodness, knock on wood, the eye was saved. It led to a cataract (of course) and on 1/11/12 I had cataract surgery. I see 20/25 in that eye without any correction. Images are bigger (beats smaller) but I do have slight distortion. Only noticeable on straight lines. I also had battled floaters, severe ones my whole life. After my PVD the floaters were insanely bad, disabling. I don’t buy the “it will settle down” crap cuz they never did. But the vitrectomy cured that too. At a -14 I was pretty myopic, with lattice and cobbling. Also it runs in my family. Sister had macula off retinal detachment, gas bubble and laser repaired hers, again no buckle. That was 9 years ago for her, no problems since. Sees 20/20 with slight distortion. Dad had it at age 48, they repaired it years ago with cryo, still holding strong when he passed at 83 in 2011. No buckle. Both eyes have had preventitive 360 degree lasering as well. I respect your stats doctor, but for me, the extra 5% with statistical error, isn’t worth the buckle, I would much prefer laser only.

    • Randall V. Wong, M.D. April 21, 2012 at 7:52 am

      Dear RobK,

      Congrats to you. You have a true appreciation of how lucky you are! Thanks for sharing.

      r

  • RobK April 18, 2012 at 2:30 pm

    Wanted to add that for those people worried about future detachments, check into laser cerclage, its the 360 degree preventative that is being done. This surgery isn’t your father’s cerclage, improvements have been made and this a great option. Google it.

    One cool thing I had which a lot of people will not experience, is that my cataract lense has a 0.00 power. In other words, based on the length of my eye 30 mm (which is llloooonnnnggggg), cornea shape etc., for me to see 20/20, the doctor only had to remove my cataract lense. They measured me 3 times and on the operating table. My MD was Dr. Douglas Koch, one of the best in the country (I live in Houston). So right now, my left eye has a contact, right eye sees 20/25 and almost 20/20 without anything. And my retina surgeon held up his hands and made a big fat zero and said, “this is how much retinal problems you will have after your cataract surgery.” Dr Eric Holz, considered a superdoc, he saved my sight.

    Also, for those of you who don’t know, after you laser your retina in place, your retina is “stronger than the day you were born.” Retina docs words. Googled it and boy he’s right. They did some rabbit retina studies at Stanford which I read, puts healed lasered retina’s strength to be 3 times normal by 2 weeks.

    Anyway, do your research before you buy!

  • RobK April 18, 2012 at 2:33 pm

    Ok, last post. Sorry, just want to help those who have had RDs. No MD ever told me this but my retina doctor. Only after he was asked…

    For those of you who have very thin retinas cuz you are highly myopic, with lattice and cobbling, ask the MD how your MACULA looks. At the end of the day, that’s your central vision. I was told my macula was perfectly normal and healthy. Nice to hear after being beaten up my whole life about how thin and fragile my retina was….

    • Randall V. Wong, M.D. April 21, 2012 at 7:55 am

      RobK,

      Agreed, but not just for highly myopic. Macular function is what gives everyone 20/20 and best color perception.

      Thanks again.

      r

  • Liesel Meier April 21, 2012 at 4:03 pm

    Dear Doctor Randy,
    Thank you so much for you response. I made an appointment with a pediatric ophthalmologist for the end of next month.
    I do have an additional question for you. Is it common to remove a buckle. Also, how dangerous would that be re. Retina detachment. According to the surgeon who put the buckle in, it was a small tear on left lower side. He stated, that he has no problem with the buckle being removed, but never suggested that he would do it….

  • Cesar Samaniego May 24, 2012 at 1:03 pm

    Dear Dr Wong

    I want to thank you and your team as well as the staff of the Hospital for their excellent service and treatment I received during my surgery. We will recommend widely, waiting to continue helping people for a long time.

    Thank you Cesar S.S.

  • Jake Rashid May 25, 2012 at 4:07 pm

    I am grgeryoing to have caatarac surgery on an eye that has a psuedo hole in the retina
    Is it okay to have catarac surgery?
    Thank You
    Jake

    • Randall V. Wong, M.D. June 4, 2012 at 2:30 pm

      Yes. I think I answered you on the other post, too.

      Sometimes the ERM gets worse shortly after surgery, so I’d recommend pre-operative or post-operative evaluation with a retinal specialist.

      r

  • Casey May 28, 2012 at 6:43 am

    Hi I m 26 and have had the buckle and was wondering i work on a farm and have to left alot and was wondering how this would effect my work and I also play basketball and base ball and I don’t no what I can and can’t do should I stop playing sports or can I do what I was doing

    • Randall V. Wong, M.D. June 4, 2012 at 3:21 pm

      Dear Casey,

      If you were my patient, I would tell you that you don’t have any physical restriction once the buckle has been placed and you have healed…none.

      Randy

  • marina plummer June 7, 2012 at 11:32 am

    Dear Dr Wong

    Can you give me some advise… my husband had several detachments in his right eye over the past 2 years but about October 2011 his left eye had a detachment after removal of a catarach and was operated on carrying out BOOB procedure by means of an encircling band and a tyre.
    Today he woke up with another detachment in the left eye … what are our chances of recovery. We are hoping they will be operating on him tomorrow… please help.
    thanks a lot…. am really worried.

    • Randall V. Wong, M.D. June 18, 2012 at 9:25 am

      Dear Marina,

      I am so sorry about all of his troubles.

      I have no idea what a BOOB procedure is, but you describe a scleral buckle (encircling band and tire).

      Every detachment and every patient have a different prognosis.

      Please update us…he must have had surgery by now.

      Randy

  • marina June 7, 2012 at 11:34 am

    Dear Dr Wong

    Can you give me some advise… my husband had several detachments in his right eye over the past 2 years but about October 2011 his left eye had a detachment after removal of a catarach and was operated on carrying out BOOB procedure by means of an encircling band and a tyre.
    Today he woke up with another detachment in the left eye … what are our chances of recovery. We are hoping they will be operating on him tomorrow… please help.
    thanks a lot…. am really worried.
    marina

    • Randall V. Wong, M.D. June 18, 2012 at 9:26 am

      Marina,

      I am sorry for the delay. I try to respond to most comments within a week.

      By now, surgery must have been performed. I wish him well!

      Randy

  • sheryl June 9, 2012 at 9:15 am

    Dear doctor Randy,
    My husband was diagnosed with a RD last April 9, 2012…he had vitrectomy,gas bubble and laser last April 16, After a few weeks of follow up check ups, he was again told to have another tear which requires another operation, he was again operated last May 31, 2012 another vitrectomy and gas bubble was done together with a scleral buckle, my question is that is it normal that until now my husbands operated right eye is still bleeding?and he has this red lump under his eye that looks like a bleeding muscle…is it normal?and after this procedures is it still possible to have another detachment, his doctor also told him that he had cataract, is it safe to remove that after 3mos of operation? I hope you will answer my questions, Thanks and God Bless

    • Randall V. Wong, M.D. June 18, 2012 at 9:34 am

      Dear Sheryl,

      Wow.

      1. Bleeding outside the eye after a scleral buckle is common, but continued bleeding is not. Ask your doctor if you are concerned about continued bleeding. I obviously can’t tell without examination.
      2. After any procedure, it is always still possible to redetach.
      3. Cataracts can commonly follow retinal detachment surgery and cataract surgery can be considered at some point.

      All the best.

      Randy

  • Linda June 25, 2012 at 5:20 am

    Dear Dr. Wong,
    My husband has had a torn retina for about 1 year he guesses. He remembers a lot of floaters during our move last June. He is not in any pain and only has a small decrease in his vision and as far as he can tell no change since last June. When the Dr’s look in his eye they seem “confused” by what they are seeing, this has occurred with the 2 Dr’s he has seem this month. Thus his confidence in them and rush to surgery is not providing confidence in them.. The Dr’s want to do a vitrectomy with oil ASAP. He is not sure he wants to have this done given the chance his eye sight will not improve in his case. If nothing is done..what can he expect?
    Thank-you in advance.
    Linda

    • Randall V. Wong, M.D. June 27, 2012 at 7:46 am

      Dear Linda,

      I am not sure if I understand your husband’s situation….has he lost vision with the retinal detachment?

      Do you know what is confusing them?

      I would agree about the lack of confidence given the confusion, but I wouldn’t base the decision regarding surgery on just emotion.

      Perhaps a “3rd” opinion is warranted.

      Randy

  • Linda June 27, 2012 at 12:03 pm

    Dr Randy,
    My husband is 61 and he has NOT lost his vision. He states it is blurred in his right eye and does not see clearly. He has no pain and no floaters. The Dr does not say much, however they keep looking and looking, then say he must go to surgery. What will happen if he does nothing about the stated torn/detached retina?
    Thank-you so very much,
    Linda

    • Randall V. Wong, M.D. July 10, 2012 at 5:42 am

      Dear Linda,

      Does he indeed have a retinal detachment?

      If the retina is torn he might require laser or freezing…sometimes mother nature takes care of the “treatment” herself, but you can only tell by examination.

      Retinal tears have the likelihood of progressing, or causing, retinal detachment…a potentially blinding problem.

      Randy

  • Rheba Sims June 29, 2012 at 4:30 pm

    Dr. Wong. My daughter had retinal detachment surgery last Aug., 2011 and has had double vision ever since. She had the surgery done in Lexington, Ky., and the double vision is driving her crazy!! She is a dairy farmer, and has to milk, as our only source of income, . She has no insurance, so is paying for the surgery in pmts., so I would like to know if there is anything that can be done to correct the double vision. She is still wearing the prism glasses and can only see out of one eye. Thank you for a response.

    • Randall V. Wong, M.D. July 10, 2012 at 6:26 am

      Dear Rheba,

      There are so many causes of double vision, but prism and strabismus surgery can often correct double vision from misalignment. Other causes are not true double vision and due to unequal refractive needs of the two eyes…one eye needing much different lenses than the other.

      My suggestion is to speak to your daughter and try and determine the exact nature of her complaints…and then go from there.

      Randy

  • KathleenInVA July 17, 2012 at 9:25 am

    I recently experienced sudden onset of flashes of light in the peripheral vision of one eye accompanied by sudden increase of floaters in my peripheral vision. The symptoms are most noticeable in dim light, such as a movie theater and look light a shooting star, always from top to bottom and always in left periphery. The pressure in my eyes was measured and found to be normal and my blood pressure is normal. An eye exam was done using both the Optos retinal imaging and traditional exam with dilation. I have two questions. First, how easy would it be for an eye doctor to miss a retinal tear or detachment? Second, your website states that “most” people w/flashes and floaters don’t have tears or detachments. Can you quantify that percentage a bit more? I am 60 yrs old and otherwise in very good health.

    • Randall V. Wong, M.D. July 19, 2012 at 1:37 pm

      Dear KathleeninVA,

      1. The Optos is a screening tool. I would encourage you to get your eyes dilated and have your retina inspected by someone you trust or retina specialist. The single best way to detect a retinal tear is by direct visualization by someone comfortable with retinal tears.

      2. Most people? I’d guess somewhere around 1%. In patients with a PVD, Less than 5-10%.

      Given your age, I’d make sure you are not developing a PVD. A posterior vitreous detachment occurs in everyone as we get older and may cause a tear in the retina. The PVD is commonly the causes of new flashes and floaters.

      Randy

  • JulieW July 31, 2012 at 12:00 am

    I have had Type 1 diabetes for 29 yrs. Yearly dilated eye exams for 25 yrs with only a few very tiny microaneurysms. However Sept 2010 (9 months after an eye exam) I had laser treatment due to PDR with focal retinal detachment asociated with vitreal retinal traction. My eye was stable for about a yr. Oct 2011, I experienced extension of the detachment involving the macula and had a vitrectomy, endolaser, & ERM (star fold) peel, which caused a 2nd area of detachment in the retina temporal to the macula. I remained face-down 24/7 for a week (only getting up every 3 hours for 10 minutes) and was face-down 50-75% of the time the 2nd week. Three months after vitrectomy, my vision was 20/30. 8 weeks later, my vision was 20/60 and after another 8 weeks vision was 20/70. (it can corrected to 20/30 with glasses). I have been to both my “regular” ophthalmologist and to the retina specialist who did my surgery and both say my eye looks good and except for +1 cataract, they do not see a problem. My vision has worsened some in the past 2 months which I expected as both drs had told me that they expect my vision to worsen.

    I am wondering if this would be just due to the beginnings of a cataract or would this be something else,?

    I have noticed that when looking at the moon, I see a double image. When looking at a light in the distance, I see what kinda looks like a coat hanger. An airplane (at night) looks similar to a wind turbine. Is this normal or anything to be concerned with?

    Thanks for your input.

    • Randall V. Wong, M.D. July 31, 2012 at 11:30 am

      Dear JulieW,

      I’m thinking you should have your cataract re-examined and go from there!

      Randy

  • JulieW July 31, 2012 at 10:18 am

    Added Note to previous post. Ok, I know the vision issues isn’t normal. I should have probably asked if this was anythingto worry about. Since my vitrectomy, looking at a straight….it is not a straight line to me….there is a break in the line and it is slightly off kilter (almost like a with a break in it). Also everything looks smaller and further away in that eye.
    It has been 9 months since surgery. I would assume that there will not be any further improvement in my vision?

    • Randall V. Wong, M.D. July 31, 2012 at 11:32 am

      Dear JulieW,

      You could be suffering from several problems…one of which is a cataract. Hard for me to be more certain from my vantage point.

      Randy

  • Jeff August 20, 2012 at 11:17 am

    Good Morning Dr. Wong –

    I wish I had located your fine website and blog a couple of weeks ago, before my surgeon told me I needed emergency surgery for a partially detached retina. Please allow a little background. I am a 47 year old married male, non-smoker, living in Upstate New York, who has been near sighted since the age of 11. On August 6, 2012 when I had a scleral buckle procedure on my right eye, I was a -7.00 in each eye and have seen very well with contact lenses and glasses for as long as I can remember. I am a professional sports photographer by trade.

    About 1 month ago I began seeing what appeared to be a tiny flashlight image in my right eye, about twice per day. I called my optometrist who referred me to an eye surgeon the same day. Following an exam the same day, the surgeon said he saw nothing extraordinary, but was referring me to a retina speicalist just to be sure. 1 week later on 8/2/12, I visted Mohawk Valley Retina and Dr. Steven Williams, who informed me that he wanted to do a scleral buckle procedure that evening at a local hospital. I was shocked, scared and said that due to some work commitments I wanted to wait a few days, at least. Dr. Williams appeared unhappy with my decision and to say the least, he was the most cold and uncomforting physician I have ever enclountered.

    They scheduled my surgery for Monday, 8/6 with Dr. Williams’ partner, Dr. Joseph Gale, with a pre-op appointment at their office that morning. After a weekend of agonizing, researching and worrying, I went ahead with the appointment with Dr. Gale. I was met with “well are you going to get this done or not, they (his staff?) tell me you have some reservations”. I sure did have some reservations, I went from seeing perfectly to being told I had a blinding condition. I went ahead with the surgery because Dr. Gale convinced me it was necessary.

    On 8/6 at about 4 pm I had the scleral buckle surgery at St. Elizabeth Hospital in Utica, NY. About halfway through the surgery I awoke to feel unbearable pain in my right eye, along with extreme bright light and Dr. Gale telling me I needed to calm down and be still. I awoke in the middle of the surgery. I was really hoping it was a nightmare!!

    Anyway, the Dr. finished the surgery and told me that it took about 45 minutes longer than normal because I was “so senstitive”. I went home that night with a patched eye and told to follow-up with him at his office the next morning. Which I did.

    Dr. Gale told me that everything looked good in the eye, but that there was about 10% of the fluid that was causing the problem remaining in my eye that needed to “go away” and thet he thought it would.

    7 days later I saw the ever chipper and reassuring (note sarcasm here) Dr. Williams who told me the fluid was still there and that he thought it was 50/50 that I would need a vitrectomy to remove it. Williams told me to basically man up, he said you’ve got a blinding condition and we can fix it, we’re good at it” I was devestated, to say the very least. I have another appointment on 8/23 with Dr. Gale to check the progress of the nuisance fluid.

    Aside from being shocked with all of this news and the trauma from the surgery, my surgeons and their extremely young group of technicians who field their calls and questions for them do not offer much information on what to expect.

    I am now 14 days post surgery and my eye isn’t very swollen, but its still closed. I find myself closing it more than I probably should to use my left eye to function. Is this normal? I also find my vision in the right eye is better in the morning and in the evening.

    I also know I have some sutures in the eye, where are they? When will they dissolve? At what point can I put a contact back in my right eye and get back to work? At first Dr. Williams told me “a couple of weeks” of recovery. One of his young technicians told me last week that its more like 3 to 5 weeks. I explained that I was seeing floaters and a flashing spot when I blink, to which she replied “you’re going to see some funky stuff for a while that’s for sure”. Now, I’m reading that it could be months and months to recover. While I can certainly appreciate that recovery is variable from patient to patient, I am hoping to at least get a ball park estimate as to what to expect.

    Any advice that you can offer would be very much appreciated. I really wish I had found you earlier, I would have to come to Virginia for a consult with you the same day!

    Thank you!

    Jeff

    • Randall V. Wong, M.D. August 28, 2012 at 7:52 am

      Dear Jeff,

      Update me on your status. Many times “extra fluid” is a euphamism for “likely to operate again.”

      Sutures will dissolve. I agree 2-4 weeks or so.
      Contact lens? Maybe months depending upon how fast your eye heals from the buckle. You’ll notice the eye gets irritated/red much easier than your other eye. This may occur for a year. You’ll need a new contact lens prescription due to the buckle.

      I am most concerned about the extra fluid.

      Good luck. Look forward to hearing from you.

      BTW: I like your pics!

      r

  • Chip Perkins August 23, 2012 at 9:08 pm

    A great educational video, even for someone who has had the surgery. Thanks for posting!

  • […] 5.Surgery for Retinal Detachment – Eye Diseases of the Retina Jan 19, 2012 … After the scleral buckle is placed, I then go inside the eye and repair the retinal detachment from the inside by performing a vitrectomy. This “3 … http://www.retinaeyedoctor.com/2012/01/how-to-fix-a-retinal-detachment-surgery/ […]

  • Jeff September 4, 2012 at 9:04 am

    Hi Again Dr. Wong –

    Thanks for your reply. Here’s my current status. I am 4 weeks post scleral buckle surgery. I have seen a nice improvment in my vision in the last 2 weeks. My eye is still wanting to remain closed, but I open it for limited periods with my glasses on and its definitely getting better. Still VERY red, I can still see two sets of sticthes, which irritate me sometimes. It drains a white mucus a couple of times a days. Pain is minimal.

    On 8/23 I saw Dr. Gale for a follow-up. Whereas Dr. Williams seemed to be leaning toward a vitrecomy to remove the fluid that remained following the SB surgery, Dr. Gale told me this visit that the fluid had diminished some and that he didn’t think another surgery would be necessary, at least right now. He said the eye and the buckle looked good.

    As for a contact lens, he said the 6 to 8 week mark might be realistic to try to put one in, but that the prescription might change a couple of times after that,

    One concern that I conveyed was that I was purposely closing my right eye to work and basically function with a contact lens in my left eye. Dr. Gale said not to worry about that and in fact I was worrying about things that I shouldn’t be. While that may be true, I was just concerned about slowing my right eye’s heailing by closing it so much. Is that a weird question?

    I got a more mature and seemingly more knowledgable technician for my last appointment as well, which made me alot more comfortable. I am in no way trying to knock this office, but I just didn’t feel comfortable at all, and I really still don’t. The Doctors have to really try to be compassionate I think. Plus, I’m always the youngest patient in the waiting room by 25 years….

    Anway, thanks so much for the response. I want to do everything and anythin that I can to make a great recovery. Any tips you can give me toward that end would be most appreciated.

    Thanks also for the compliment on my work. I’m entering my busy time of the year as well, which is stressing me beyond belief also.

    Have a great day and thanks for your great web site.

    Jeff

    • Randall V. Wong, M.D. September 11, 2012 at 9:49 am

      Jeff,

      Glad things seem to be moving forward.

      No, closing the eye is okay and does not impact healing from the detachment.

      It’s always interesting to watch the mix of younger patients with older patients in a retina waiting room!

      Randy

  • Jeff September 12, 2012 at 12:14 pm

    Dr. Wong –

    I saw Dr.’s Gale and Williams together on Friday, Sept 7th. They agreed that the fluid that seems to want to hang around “diminished a little bit”. They want to see me regularly, the next visit being 2 weeks from now. Both used the word “rational” to describe their decision (and mine) to hold off on a vitrectomy, at least for now. I don’t think I can go through this again unless absolutely necessary.

    As far as my affected eye, Dr. Gale removed my stitches last Friday because they weren’t dissolving. That HURT. But the eye feels much much better without them.

    I thought that you would find it interesting that Dr. Gale gave me permission to see my optomitrist and put a contact in. Much to my surprise, my prescription has only dropped from -7.00 to -8.00 in that eye and I am seeing very well. The only thing I have is what appears to be a “sack” of floaters at the top of my field of vision which I never had before. Will this go away do you think?

    Again thanks for listening. This site and your posts have helped me tremendously!

    Jeff

  • […] 12.Surgery for Retinal Detachment – Eye Diseases of the Retina Jan 19, 2012 … This is my latest recording of surgery for a retinal detachment. … occur due to reduced operating time and increased experience of the team. …. basketball again this soon after surgery be okay from your professional opinion? http://www.retinaeyedoctor.com/2012/01/how-to-fix-a-retinal-detachment-surgery/ […]

  • Judy Dennis October 28, 2012 at 9:07 pm

    Dr. Wong, Thank you for this website and all the useful information. I had the Silicone injection Sept. 18th after two unsuccessful Vitrectomies with gas. First for a wrinkle that became a hole then a detached retina. I am experiencing pain in the affected eye esp. when tired or in bright light. Also when I bend over I feel like my left side of my head will explode with severe pounding pain. Is this pain normal? The bending over part just started this past week. Still no vision but that wreally wasn’t planned for. Thank you for any insight you may have.

    • Randall V. Wong, M.D. October 30, 2012 at 12:24 pm

      Dear Judy,

      Pain is never “normal.”

      You may have some inflammation in the eye…or you might be allergic to some of the drops. Make sure your doctor is aware!

      r

  • sheel singhal October 29, 2012 at 4:52 am

    Hello dr….
    I m sheel (from India).My brother lost one eye vision suddenly.His age is 18 yr old.
    Can u give your Email ID so i will forward all the details…PLZ help me and reply ASAP.
    its very very urgent…..
    thanks

    • Randall V. Wong, M.D. October 30, 2012 at 12:32 pm

      Dear Sheel,

      Please contact Chrissy if you’d like to send records for me to review.

      For me to review specific records and render an opinion will require that we establish a formal relationship.

      I will have Chrissy email you and you can decide if you’d like to proceed.

      Randy

  • What to Expect Following Retinal Surgery November 2, 2012 at 6:10 pm

    […] repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or retinal detachment surgery; the post-operative exam is […]

  • Cesar Samaniego November 29, 2012 at 11:39 pm

    Dr Wong, thank you again for your good service and support, I feel better after the surgery you made on my eye for retinal detachment.

    All the investment I made on my trips from South California to Washington DC (Virginia) is nothing compared to if I had not attended with you.

    Thank you and all your group too.

    Regards

  • Doug Pribble February 6, 2013 at 7:32 pm

    Kuddos for posting this video, Dr. Wong. I had a buckle/vitrectomy August 2012 and was wondering why, in Feb 2013, my eye still cannot tolerate a contact lense for more than a few hours. I now realize where it sits was (likely) where my doc did the conjunctiva incision, and it is still somewhat sensitive. I will not be worrying so much about the eye irritation anymore! Thanks so much for your very informative site. Knowlege is the best weapon against post-surgery anxiety.

    • Randall V. Wong, M.D. February 13, 2013 at 12:22 pm

      Doug,

      Hmmm. I would think your conjunctiva would be better healed. I do know, however, the conjunctiva gets irritated quicker than the other eye for about a year. I don’t know if that is part of the problem.

      r

  • darren May 1, 2013 at 6:00 am

    Hi Dr Wong,

    Few days ago, my right eyes started experiencing flashes. While the flashes are different from what i have experienced in the past ( i have a history of retina tears in both eyes) , i cound’lt help but worry. The kind of flashes i experienced were like a photography flash in the whole of the eye in constrast to the past, where i see sparkles and fireworks in the side. Does it signal a retina detachment? or could it be another episode of a migraine

  • BruceS January 3, 2014 at 1:29 pm

    Good Day! Okay here’s MY situation … Almost 60 year old male. I had Lasik both eyes 20 years ago (approx.). Several years later, cataract surgery both eyes. Vision good at this point. Have had floater issues for awhile, but dealt with them not too much of a problem. Night vision pretty poor. Nine months ago had a retinal tear that I waited on and turned into detachment. Scleral buckle and gas bubble procedure. Several months later I had these new larger contact lenses prescribed (I install and remove them with little suction cups, and there’s a layer of saline fluid that sits between my contact and cornea) Anyways, the issue I’m having with my scleral buckled eye, is that the vision through that eye, although relatively clear via the contact lens, is quite distant. I’d say that
    maybe 30% smaller that my “good” eye (plus a little off kilter/angled). I’m thinking that maybe the installed buckle has slightly elongated my eye, thus distancing the lens from the retina, thus making things look further away. I’m a pretty happy 58 year old, who has always enjoyed some sports….tennis, golf etc., but with this ‘two vision’ issue, my depth perception is really wacky, and driving, tennis and such is getting too difficult. The bottom line question is this… will removing the scleral buckle bring that distant image closer?

    • Randall V. Wong, M.D. January 4, 2014 at 2:46 pm

      BruceS,

      Sounds like you need evaluation by a pediatric ophthalmologist. I think you anisometropia (one eye has a much stronger prescription than the other). You are correct in that this might be caused by the scleral buckle, but cataract may also be contributing, too.

      I don’t think removal of the buckle will reverse the increased myopia normally associated with the scleral buckle. While it may be counter-intuitive, the eye usually does NOT regain its previous “non-buckled” shape. Normally external scar tissue forms over the buckle and prevents the eye from regaining its “unbuckled” shape.

      Randy

      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia 22030

      TotalRetina.com

  • Michael February 13, 2014 at 2:07 pm

    Hi Dr.Randall Wong!
    I am 26 year old male from Toronto Canada and found this amazing blog and was surprised to see you actually reply to patients!!
    I recently have had surgery for a retinal
    Detachment in my left eye about 6 weeks ago.
    My retina is attached but the problem i have is
    Its been 6 weeks, and my eye is still pretty red and inflamed. I have also developed a small blister which the doctor said it was a granuloma and it will go away on its own. I have been using prednisolone drops for about 6 weeks and the doctor advised me to continue the drops?
    Im worried this will cause me cataracts and my pressure has been elevated to about 26-28 these past two weeks. My next appointment is in two weeks, so im not sure what to do?
    How long will the inflammation and redness go away? Will the blister really reside on its own? And what should i do about the spiked IOP?

    Thank You!!!!

  • Michael February 18, 2014 at 10:47 pm

    Hi Dr.Randall Wong

    Yes, I did have the scleral buckle procedure
    Done. I guess only time will tell if the redness
    Will go away. However, im more concerned
    About the use of steroid drops long term.
    Ive read that they can increase IOP
    As my last two appointments with my surgeon
    Measured at 26-28 mg. I know that its relatively
    High, but he didnt seem to concerned.
    Should I be worried?

    Thank you!!

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offices

Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Capital Eye Consultants
Randall V. Wong, M.D.
Contact: Brigitte O’Brien

A: 3025 Hamaker Court, Suite 101 • Fairfax, Virginia 22031
Ph: 703.876.9630
F: 703.876.0163
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Andrea Armstrong (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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