Retinal Detachment: Complications and Treatment Options

Retinal detachment, scleral buckle protrusion, inflammation, bubbles?

I discovered a retinal detachment in my left eye at the beginning of April and underwent scleral buckle and cryopexy.
One week post-surgery, due to fluid accumulation that had not been absorbed, I received an injection of 0.3 cc of C3F8 gas bubble.
My attending physician mentioned that my retina has reattached, and I also received laser reinforcement.
However, one month after the surgery, the gas bubble remains large with almost no absorption, and I can feel the buckle, which is painful and occasionally produces a small amount of bloody tears.
My post-operative intraocular pressure has been around 10.
Recently, I consulted another ophthalmologist regarding a stone issue in my right eye, and they noted signs of inflammation in my left eye and prescribed anti-inflammatory medication.
This doctor advised that if there is no improvement after finishing the medication, I should seek a referral.
After taking the anti-inflammatory medication, the pain from the buckle subsided, and my eye appeared less red.
However, once the medication was finished, moving my eyeball caused pain again at the buckle site.
My attending physician has consistently told me that my eye will hurt and has not addressed my concerns.

I have the following questions:
1.
Does this situation indicate that my buckle is inflamed?
2.
Is it necessary to remove the buckle just one month post-surgery? Would this lead to a re-detachment of the retina?
3.
Could the persistent gas bubble be related to the inflammation? Is it possible to aspirate the gas bubble?
4.
Would removing the buckle change my vision? Another doctor mentioned that I have some cataracts, but I am concerned that if the buckle is inflamed and not removed, my vision may continue to change, and I cannot replace the lens to address the myopia caused by the buckle.

27 years old, myopia 300 degrees, 20~29 year old female. Ask Date: 2019/05/14

Dr. He Jianxian reply Ophthalmology

1.
Foreign body implantation requires a period of adaptation, and it should be monitored without immediate removal.

2.
It has only been one month since the procedure, and removal of the ring is not recommended; in fact, it is not necessary to remove it.

3.
The bubbles will definitely disappear and do not require any treatment.

4.
Removal of the ring is not advised.

Reply Date: 2019/05/14

More Info

Retinal detachment is a serious condition that can lead to permanent vision loss if not treated promptly. It occurs when the retina, the light-sensitive layer of tissue at the back of the eye, separates from its underlying supportive tissue. Your situation, involving a scleral buckle and C3F8 gas bubble, is a common surgical approach to reattach the retina. However, the complications you are experiencing, such as persistent pain, inflammation, and the size of the gas bubble, warrant careful consideration.

1. Inflammation and Pain: The pain you are experiencing, especially when touching the buckle, could indicate inflammation. Inflammation can occur post-surgery due to various reasons, including the body's response to the surgical procedure itself or the presence of foreign materials like the buckle. It is crucial to monitor this symptom closely, as persistent inflammation can lead to complications such as scarring or further retinal issues.

2. Need for Buckle Removal: The decision to remove the buckle should be made cautiously. Typically, a scleral buckle is left in place unless it causes significant discomfort or complications. Removing it too soon could risk re-detaching the retina. Your surgeon will consider the overall health of your retina, the presence of inflammation, and your symptoms before making a recommendation. It is essential to communicate your concerns and symptoms clearly to your primary surgeon.

3. Gas Bubble Persistence: The C3F8 gas bubble is designed to help hold the retina in place while it heals. It usually starts to absorb within a few weeks, but factors such as inflammation can affect its absorption rate. If the bubble remains large for an extended period, it may be worth discussing with your doctor whether it can be aspirated, although this is not common practice unless there are specific complications.

4. Impact on Vision: The presence of a scleral buckle and any inflammation can affect your vision. If the buckle is inflamed, it may lead to changes in how light is focused on the retina, potentially causing blurred vision. If you have developed cataracts as suggested by another physician, this could further complicate your visual acuity. Cataracts can develop after retinal surgery, especially if there is inflammation or if steroid medications are used post-operatively.

In summary, your symptoms of pain and inflammation should be taken seriously. It is essential to maintain open communication with your healthcare providers about your concerns. If your primary surgeon is not addressing your symptoms adequately, seeking a second opinion may be beneficial. The management of retinal detachment and its complications is complex, and a tailored approach based on your specific situation is crucial for the best possible outcome.
In the meantime, ensure you follow your prescribed medication regimen, including anti-inflammatory medications, and attend all follow-up appointments. Monitoring your symptoms closely and reporting any changes to your doctor will help in managing your condition effectively.

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