Treatment of retinal detachment
A retinal detachment is a serious condition that can lead to blindness if left untreated. Only surgery can save the eye. Make an appointment today with Dr. Pion, the retina surgeon at Focus Eye Clinic.
The different treatment methods for retinal detachment
Retinopexy: Treatment of a new and small retinal detachment
For a new and small retinal detachment, an external, minimally invasive procedure can often be performed. This method is especially appropriate when the detachment is caused by a single small tear in the upper part of the retina. This type of treatment is less invasive than a full vitrectomy and provides an effective solution for incipient retinal problems.
The procedure begins with locating the tear in the retina. Next, cryotherapy is used, a technique in which the tear is "sealed" by controlled freezing. This freezes the surrounding tissue and causes scar tissue to form, permanently sealing the tear. Cryotherapy is a safe and effective method to prevent further detachment of the retina.
After repairing the tear, a gas bubble is injected into the eye. This gas bubble exerts gentle pressure on the retina, pressing it against the back wall of the eye and bringing it back into place. The gas is naturally absorbed by the body over time. During this time, it may be necessary to remain in a specific position (for example, with the head down) so that the gas bubble continues to press into the correct place.
This treatment is effective in simple cases of retinal detachment and offers rapid recovery without the need for extensive surgery. However, success depends on timely diagnosis and correct assessment of the extent of the detachment. More extensive detachments or multiple tears may require another, more complex procedure.
Cerclage for retinal detachment: The conventional ablatio retina operation
Conventional ablatio retina surgery, also known as cerlage, is an external procedure often used in younger patients with retinal detachment. In this procedure, a thin silicone band, also called a cerclage band, is placed around the eye. The purpose of this technique is to reduce the tensile forces of the vitreous on the retina, which can prevent further damage and allow the retina to recover.
The silicone band is strategically placed to redistribute the pressure on the retina. This effectively closes the holes or tears in the retina responsible for the detachment. This helps the retina return to its original position and function properly again. The band also provides lasting support, minimizing the risk of new tears or detachments.
This surgery is less invasive than internal procedures such as a vitrectomy and has proven to be an effective solution, especially in patients where the retinal detachment is due to small tears or traction by the vitreous. Although the procedure requires some recovery time, cerlage offers a good chance of success and helps patients maintain or improve their vision.
Vitrectomy: the most commonly performed surgery for retinal detachment
Vitrectomy is the most commonly performed surgery for retinal detachment. One will choose this technique when an external procedure is not appropriate. (e.g. with cloudy vitreous, with too many or too large tears). The first step of the vitrectomy is to make 3 microscopic openings in the sclera (=white part) of the eye. Next, instruments will be inserted through these openings. At the first opening, the drip of water is applied. This way the eye will always keep its shape during the operation. Through the second opening, the endo light will be brought in so that everything can be seen. The vitrectomy is inserted through the third opening. This vitrectome is a small tube that cuts away and aspirates microscopic particles of the vitreous. The removed vitreous is replaced with clear water. The retina will be reconstructed via heavy fluids and the tear will be closed with laser. To hold the retina in place until healing is complete, a gas bubble or silicone oil will be placed in the eye. The gas bubble will gradually disappear from the eye and after about two weeks you will be able to see better again. As long as there is gas in the eye, you should not travel by plane or go to high altitudes (mountains).The silicone oil will need to be surgically removed again after a period of a few weeks to months.
From 2010 to 2023, Dr. Pion was head of eye surgery at St. Peter's Hospital in Brussels. During these 13 years, he took on the most complex surgical cases and led a team of more than 20 surgeons.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Personalized advice from our experts
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
The course of a vitrectomy at Focus Eye Clinic
Step 1: Arrival and preparation at Focus Eye Clinic
Upon arrival at Focus Eye Clinic, you will receive a friendly welcome at the front desk, where our front desk assistants will register and prepare you for your surgery. Next, your pupil will be dilated (dilated) in preparation for the procedure. To make your experience as comfortable as possible, you will be given a relaxation pill. After all, surgery can be exciting, but our dedicated team of three nurses, two healthcare professionals, an anesthesiologist and Dr. Pion will guide you step by step.
Surgeries are always performed under local anesthesia, so you experience no pain and are completely at ease. This is always done under the supervision and guidance of our experienced anesthesiologist, who monitors your comfort and well-being throughout the procedure.
Step 2: Surgery of vitrectomy under local anesthesia (20 minutes - 1 hour)
The vitrectomy is performed under local anesthesia, so you will experience no pain and be completely at ease. The procedure itself takes an average of 20 minutes to 1 hour, depending on the complexity. During the surgery, the eye surgeon removes cloudy vitreous and replaces it with a clear liquid, which improves your vision.
Step 3: Get some rest before heading home
After the vitrectomy, you will be taken care of in our specially equipped relaxation area, where our dedicated nursing team will be there for you. Here you can rest peacefully and receive personalized care and attention. Our team will explain to you step-by-step instructions on postoperative treatment so that you are well prepared for your recovery at home. Once you are comfortable and have received all the information, you may safely leave for home. At Focus Eye Clinic, we strive to make your entire experience, from surgery to aftercare, as pleasant as possible.
How is a vitrectomy performed?
First step: inserting the trocards.
First, 3 separate openings will be made in the hard eye skirt (white sclera). The diameter of these openings is 0.57 mm. Three small tubes are placed in these openings through which the instruments enter the eye.
- At the first hole, the water drip will be placed.
- Through the second hole, the intraocular light will be inserted so that everything can be seen.
- Along the third hole, the vitrectome or intraocular forceps will be inserted into the eye.
Second step: removal of the vitreum
Through the vitrectome, the vitreum will be removed. The vitrectome is a small needle with a microscopic blade (guillotine) on the end. Small pieces of vitreum are aspirated into the vitrectome and cut off through the guillotine blade. Thus, the entire vitreum will be removed.
Third step: Manipulations on the retina
Depending on the condition, work will then be done on the retina. In a retinal detachment, the retina is brought back into place via special fluids. In membrane removals, a blue dye is introduced into the eye and then removed via ultra-fine tweezers. This stage is the most delicate step.
Fourth step: endolaser
To protect the retina from retinal detachment, an endolaser barrage will be performed at 360°. Studies have shown that this greatly reduces the risk of retinal detachment after vitrectomy.
Fifth step: insertion of the glass moisture substitute
Depending on your condition, the vitreous will be replaced with clear water, gas or silicone oil.
- If you eye is filled with gas, you will not see for 2 weeks. This gas may be necessary to keep your retina adjacent or to close a macular hole. However, it refers by itself. YOU MAY NOT TRAVEL BY AIRPLANE AS LONG AS THE GAS IS IN YOUR EYE.
- If your eye is filled with silicone oil you will have blurred vision. Silicone oil will be necessary if gas does not provide sufficient security of healing. Silicone will exert a stronger force on the retina to keep it in place. Silicone oil will always need to be removed with a new surgery.
Final step: closure of the eye
The final step is to close the eye by removing the
trocards. The openings are so small that they usually close by themselves. In
some cases, resorbable threads can be used. They
will disappear on their own after 4 to 6 weeks.
What is the prognosis after a retinal detachment?
The prognosis after a retinal detachment depends on several factors, including the severity of the detachment, the time between diagnosis and treatment, and the overall health of the retina. Generally, timely treatment, such as vitrectomy or cerlage, can successfully restore the retina and prevent further damage.
In most cases, vision can be partially or mostly restored, especially if the macula (the central part of the retina responsible for sharp vision) was not involved in the detachment. When the macula did become detached, recovery can be slower and vision sometimes remains limited, depending on how quickly treatment took place.
Successful re-attachment of the retina is achieved in about 90-95% of cases after initial surgery. However, vision remains dependent on the degree of damage to the light-sensitive cells. Postoperative aftercare, such as following proper posture and medication, is crucial for optimal recovery. Regular checkups with the ophthalmologist ensure early detection and treatment of any complications.
Although complete return to original vision is not always possible, prompt diagnosis and treatment offers the best chance for a positive outcome.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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At Focus Eye Clinic, we combine expertise and innovation with state-of-the-art equipment in ophthalmology aimed at treating a variety of eye conditions. With technologies such as the Ziemer Z8 Femtolaser and WaveLight® EX500 excimer laser, we perform refractive treatments (including Femto-LASIK, PRK and SMILE) with unparalleled precision.
For cataract surgery, we use advanced systems such as the Zeiss CALLISTO, IOLMaster 700 and Alcon Centurion Vision System, resulting in highly accurate implant measurements and predictable results. In addition, we use the Heidelberg Spectralis HRA-OCT, Pentacam® HR and Nidek OPD-Scan III to comprehensively diagnose a variety of eye conditions.
In the treatment of dry eyes, we deploy LipiScan and LipiFlow, among others, for lasting relief of symptoms. Thanks to this innovative equipment, Focus Eye Clinic offers safe, efficient and personalized eye care of the highest quality - fully tailored to your individual needs.
Personal approach and customized care
At Focus Eye Clinic, your care is paramount. Our team of nurses, optometrists and assistants work together with one goal: improving your vision. From your first moment of contact to your final checkup, we will guide you with a personalized and caring approach.
A multidisciplinary team for your treatment:
Our experienced multidisciplinary team offers a wide range of ophthalmic treatments. After an initial diagnosis, we refer you to the doctor who best suits your specific needs, ensuring you receive the highest quality of care.
Your personal point of contact:
Throughout the entire procedure, a permanent assistant is available to you. She knows your file inside out and ensures that all your questions are answered quickly and clearly. If necessary, she will put you in direct contact with the right doctor.
Fast and efficient follow-up
We strive to offer you an appointment within two weeks and plan with you the most convenient time. This efficient system ensures a smooth and personalized experience, allowing you to concentrate fully on your treatment.
A luxurious and comfortable setting at Focus Eye Clinic
At Focus Eye Clinic, we believe that medical treatment should be not only effective, but also comfortable and soothing. Therefore, we have designed our clinic with an eye for luxury and comfort, so that you feel completely at ease from the very first moment.
Our modern and stylish spaces exude calm and confidence, and are designed to provide you with a relaxing experience. From the warm welcome at reception to the comfortable waiting areas and state-of-the-art treatment rooms, every detail has been carefully chosen with your well-being in mind.
At Focus Eye Clinic, we combine advanced technology with luxurious surroundings, so you can enjoy the highest quality care in a setting that exudes peace and confidence. Your health and comfort are our priority, and you will notice that with every visit.
