Retinal Detachment, Macula-on, Gas

The eye functions much like a camera. It has two key components: a lens, which focuses light, and a film-like layerlining the back of the eye, known as the retina. The central portion of the retina responsible for sharp, detailed vision is called the macula.

Inside the eye is a clear gel called the vitreous, which is firmly attached to the retina. As part of the natural aging process, the vitreous gradually pulls away from the retina. In some cases, this separation can exert enough traction to tear the retina. When this occurs, fluid can seep through the tear, causing the retina to begin separating from the back of the eye—a condition known as retinal detachment.

Your retina specialist has diagnosed a retinal tear with fluid collecting underneath the retina. Fortunately, the fluid has not yet reached the macula, which is critical for central vision. Involvement of the macula can lead to distortion or permanent loss of visual clarity.

To treat this condition, your retina specialist recommends an outpatient surgery called pars plana vitrectomy. The primary goals of this procedure are to repair the retinal detachment and prevent fluid from reaching the macula. This surgery has a high success rate—approximately 90% with a single procedure. In about 10% of cases, the retina may detach again, requiring additional surgery. Following post-operative instructions carefully can help maximize the chance of success.

What to Expect During Surgery

Pars plana vitrectomy is performed in the operating room under either twilight (sedation with no pain) or general anesthesia. The surgeon places three small (half-millimeter) entry points in the white part of the eye. Through these ports, the vitreous gel and any fluid behind the retina are removed. Laser treatment is then applied around the retinal tears to create a scar that seals the edges and prevents re-detachment. This laser sealing effect takes about 5 to 7 days.

After the gel is removed, it is replaced with a self-absorbing gas bubble. This bubble floats upward and holds the retina in place while the laser-treated areas heal. Your doctor will provide detailed instructions on positioning, which typically involves keeping your head in a specific position for 50 minutes of every hour, 24 hours a day, for 5 to 7 days. These requirements may vary depending on the detachment and your surgeon’s preferences.

Important Considerations

Patients must not fly or travel to high altitudes while the gas bubble is still in the eye. Doing so can cause a dangerous and permanent rise in eye pressure.

There are two types of gas bubbles commonly used:

• SF6: lasts approximately 2 weeks

• C3F8: lasts 6 to 8 weeks
  The type used depends on the shape and location of the retinal detachment.

After Surgery

After surgery, an eye patch and protective shield will be placed over your eye. These are removed at your post-operative visit the next day by your clinical team. Vision is typically very blurry at first. Areas that were previously dark may now appear light but blurry. It's normal not to see clearly through the gas bubble. You may notice a clear area at the top of your vision, which grows over time as the bubble dissolves. When the gas no longer covers the macula, central vision begins to clear.

Patients should not drive the day of surgery or the following day. It's best to avoid driving until the gas has fully dissipated. Additionally, most retina specialists recommend avoiding lifting objects heavier than 20 pounds for at least two weeks.

Risks and Recovery

The main risk after surgery is retinal redetachment, which occurs in about 10% of cases. This is often due to an exaggerated healing response that leads to new scar tissue, typically around 6 weeks post-op. Patients with existing scar tissue at the time of surgery are at higher risk.

If you have not yet had cataract surgery, it’s important to know that vitrectomy often speeds up cataract formation. About 90% of patients over age 50 will need cataract surgery within two years after retinal detachment repair.

The main warning sign of retinal redetachment is the sudden appearance of a dark curtain in your vision, similar to what may have been experienced before the first surgery. If this occurs, contact your retina specialist immediately.

What You Can Do

The most important action you can take to support a successful outcome is to follow your positioning instructions exactly. Doing so gives the gas bubble the best chance to support the healing retina.

Please don’t hesitate to discuss any further questions or concerns with your retina specialist.