Post-Surgery Complications: Scleral Buckling Recovery Issues

Poor recovery status after scleral buckle surgery?

Hello Dr.
Wang, I would like to ask a few questions: At the beginning of January this year, I noticed a shadow in the lower third of my right eye.
After an examination at the hospital, I was diagnosed with retinal detachment and was advised to undergo surgery.
They only mentioned that I would need a scleral buckle procedure and did not inform me about potential postoperative complications (such as strabismus).

After the surgery, I experienced continuous bleeding in my eye and was instructed to apply ice for 20 minutes and then take a break for 10 minutes.
As a result, my eye swelled up to the size of an egg, and I couldn't even open my eyelids.
When the nurse attempted to measure my intraocular pressure, she struggled to lift my upper eyelid with a cotton swab.
I was hospitalized for 8 days until the bleeding finally stopped.
The doctor informed me that my eyeball is very thin and fragile, which is why I experienced these issues.
I am unsure how to respond to this.
After being discharged, I had follow-up appointments once a week.
Initially, I noticed that the shadow in the lower part of my eye had also appeared in the left and upper areas.
The doctor explained that this was due to fluid accumulation within the retina, but I feel that the fluid seems to be expanding.
During my follow-up on February 24, the doctor advised me to undergo another surgery because the fluid accumulation in the retina had not been absorbed.
This time, I would need a vitrectomy.
Currently, my vision in the right eye is 0.2 (it was 1.0 with glasses before the surgery).

Should I proceed with the surgery immediately (is it urgent)? Is there a possibility that the fluid will gradually be absorbed over time? If I undergo another surgery, can the buckle that was implanted during the scleral buckle procedure be removed at the same time (due to the strabismus issue)? I apologize for the many questions, and thank you for your assistance! Sincerely, Xiao Lin.

Xiao Lin, 40~49 year old female. Ask Date: 2016/02/28

Dr. Wang Zhishun reply Ophthalmology

Hello, it seems that in addition to retinal detachment, there may also be localized retinal detachment, which necessitates further surgery.
For simple fluid accumulation, a laser treatment can be attempted first.
The buckle implanted during the scleral buckle procedure should ideally be removed only after the retina has completely reattached for 3 to 6 months, unless there are serious issues such as infection.

Reply Date: 2016/02/28

More Info

Post-surgery complications, particularly following scleral buckling procedures for retinal detachment, can be quite complex and require careful management. Your experience highlights several important aspects of recovery and potential complications that can arise after such surgeries.

Firstly, it is essential to understand that scleral buckling is a surgical technique used to treat retinal detachment by indenting the wall of the eye (the sclera) to relieve the traction on the retina. While this procedure can be effective, it is not without risks. Common complications include bleeding, infection, and the development of new retinal detachments. In your case, the persistent bleeding and swelling you experienced post-surgery are concerning and indicate that your eye may have been particularly vulnerable due to its thinness and fragility.

The swelling and inability to open your eyelid, as you described, are not uncommon after such procedures, especially if there is significant inflammation or bleeding. Ice packs can help reduce swelling, but if the swelling persists or worsens, it is crucial to communicate this to your healthcare provider. The fact that you were hospitalized for eight days due to bleeding suggests that your situation was monitored closely, which is vital in managing post-operative complications.

Regarding the accumulation of fluid (or "water") under the retina, this can occur after surgery and may take time to resolve. In some cases, the fluid can be reabsorbed naturally, but if it persists or worsens, further intervention may be necessary, as your doctor indicated. The recommendation for a second surgery, such as a vitrectomy, is often made when the initial procedure does not achieve the desired outcome, particularly if there is ongoing retinal detachment or significant fluid accumulation.

As for the urgency of the second surgery, it is generally advisable to follow your surgeon's recommendations closely. If your doctor believes that the fluid accumulation is significant enough to warrant immediate surgical intervention, it is likely in your best interest to proceed with the surgery. Delaying could potentially lead to further complications, including permanent vision loss.

Regarding the scleral buckle and the possibility of removing it during the second surgery, this is a decision that your surgeon will make based on the specifics of your case. If the buckle is contributing to complications such as strabismus (misalignment of the eyes), it may be considered for removal. However, this decision will depend on the overall condition of your retina and the goals of the second surgery.

In summary, your situation is complex, and the decisions regarding further surgical intervention should be made in close consultation with your ophthalmologist. It is crucial to communicate openly about your symptoms, concerns, and the potential risks and benefits of any additional procedures. Recovery from retinal surgeries can be unpredictable, and while some complications can resolve on their own, others may require further surgical intervention to restore vision and eye health. Always prioritize follow-up appointments and adhere to your doctor's recommendations for the best possible outcome.

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