Retinal Detachment and Scarring After Surgery

Retinal detachment with scarring of the eye?

Hello, Doctor.
Thank you for taking the time to answer my questions.
My father has a vision of 0.7 in both eyes and has no significant ophthalmic diseases.
Last month, he visited a nearby ophthalmology clinic due to blurred vision in his right eye, where he was diagnosed with age-related cataracts causing vision deterioration.
He was prescribed eye drops and sent home.
However, one to two weeks later, his right eye vision suddenly worsened, prompting an immediate referral to a major hospital.
After examination, the doctor diagnosed him with retinal detachment, and he underwent surgery the next day.
The procedure was called scleral buckle combined with complex pars plana vitrectomy, lasting about three hours.
Post-surgery, my father diligently rested face down to allow the gas to dissipate and followed the doctor's instructions for eye drops.
His vision seemed to improve slightly, and the redness and swelling decreased.
However, during a follow-up visit a few days ago, the doctor mentioned that there appeared to be scarring in the eye.
He needs to return for another check-up next week, and if scarring is confirmed, a second surgery may be necessary after the New Year.
I have researched online and found that scarring can often prevent the retina from reattaching properly, which could lead to severe complications, including blindness.
(The online resources indicated that the incidence of scarring post-surgery is relatively low, so I am puzzled as to why this has happened to my father.) I am quite worried and hope you can help me with a few questions:
1.
Does the scleral buckle combined with complex pars plana vitrectomy indicate that my father's retinal detachment was quite severe? Is there still a possibility for successful reattachment?
2.
Does the need for a second surgery imply that the first surgery was unsuccessful?
3.
Is it possible for the scarring to resolve on its own?
I do not expect my father's vision to return to its original state, but I at least hope he can retain significant vision and avoid blindness.
I am truly anxious and would appreciate your assistance.

Danxin de nǚ'ér, 20~29 year old female. Ask Date: 2018/02/07

Dr. He Jianxian reply Ophthalmology

1.
The choice of surgical method often depends on the physician's personal judgment, and the use of multiple surgical specialties does not necessarily indicate a more severe condition.

2.
It is uncertain whether the failure was due to not assessing the patient's retinal condition, making it impossible to determine the cause.
The success rate of reoperation varies from person to person.

3.
Scarring cannot automatically disappear.

Reply Date: 2018/02/07

More Info

Hello! Thank you for reaching out with your concerns regarding your father's recent eye surgery and the potential complications he may be facing. I understand how worrying this situation can be, especially when it involves the vision of a loved one. Let’s address your questions one by one.

1. Severity of Retinal Detachment and Surgical Implications: The fact that your father underwent a scleral buckle combined with complex vitrectomy indicates that the retinal detachment was indeed significant. These procedures are typically reserved for more severe cases of retinal detachment, where the retina has either been extensively torn or there are complications such as vitreous hemorrhage. However, it’s important to note that even in severe cases, successful reattachment of the retina is possible. The success of the surgery largely depends on the extent of the detachment, the duration it was detached before surgery, and the overall health of the retina. Regular follow-ups with the ophthalmologist will be crucial in monitoring the situation.

2. Second Surgery and Initial Surgery Success: The need for a second surgery does not necessarily mean that the first surgery was a failure. Complications can arise even in successful surgeries, such as the formation of scar tissue (also known as epiretinal membrane or proliferative vitreoretinopathy) that can impede the retina's ability to remain attached. If the doctor has indicated that there is scarring, it may require further intervention to address this issue. The goal of the second surgery would be to remove any scar tissue and ensure that the retina can function properly.

3. Possibility of Scar Tissue Resolution: Unfortunately, scar tissue that forms on the retina or the underlying layers does not typically resolve on its own. This scarring can lead to complications such as distorted vision or further detachment if not addressed. The surgical intervention is often necessary to remove this scar tissue and restore as much vision as possible. While it is understandable to hope for a natural resolution, it is generally not a reliable expectation in these cases.

In terms of your father’s vision recovery, it’s important to maintain realistic expectations. While complete restoration of vision may not be possible, many patients can regain significant visual function after treatment for retinal detachment, especially if the detachment was addressed promptly. The key factors influencing recovery include the health of the retina post-surgery, the presence of any additional complications, and adherence to follow-up care and recommendations from the ophthalmologist.

It’s also worth noting that the formation of scar tissue is a known risk factor in retinal surgeries, but the incidence varies among patients. Your father’s case may be unique, and while it’s natural to feel anxious, it’s essential to focus on the next steps as advised by his healthcare team.

In conclusion, I recommend maintaining open communication with your father's ophthalmologist, asking questions about the specific findings and the rationale behind the proposed second surgery. Understanding the situation fully can help alleviate some of the anxiety you may be feeling. Wishing your father a smooth recovery and the best possible outcome from his treatment.

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