Retinal Reattachment Surgery

Retinal reattachment surgery is offered at our Pasadena, California (626-564-0202) and St. Charles, Illinois (630-444-0393) hospitals, where patients are received from around the country for surgical care.

The retina

The retina is a thin membrane that lies against the back wall of the eye. Similar to the way a camera works, images from the outside of the eye are focused by the cornea and lens onto the retina, which can be compared to the film in a camera. If the retina is not properly positioned or becomes damaged, vision is diminished or lost. The retina is only fused to the wall of the eye at its peripheral edges and at the optic nerve. Much of the retina relies on vitreous, a firm molded gel (like Jello), to tamponade it against the back of the eye.

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What causes a retinal detachment?

Although there are many types of retinal detachment, there are two main scenarios that require retinal surgery. The first is called vitreal degeneration/dysplasia, where the vitreous humor, instead of forming a semi-firm gel, liquefies. It transforms from a Jello-like consistency to a chicken noodle soup-like consistency and can no longer effectively hold the retina in place. As the eyes move, the swirling liquefied vitreous tugs on the retina, causing tears and fluid flow under the retina, separating it from the wall of the eye. The tears often progress, until the entire retina has peeled off the back of the eye. This type of retinal detachment (rhegmatogenous retinal detachment) is inherited or genetic in many breeds including the Shih Tzu, Italian Greyhound, Boston Terrier, Poodle and Terrier Breeds. Tears may be precipitated or exacerbated by vigorous head shaking during play.
The second main type of retinal detachment occurs secondary to cataracts, cataract surgery or other intraocular surgeries. Inflammation in the eye lead to areas of adhesion between the retina and the vitreous, putting traction on the retina, pulling it off the back of the eye. Retinal detachment can occur due to other causes such as trauma.

Signs of retinal detachment

Because most dogs continue to behave normally as long as one eye has vision, retinal detachment in the first eye is often missed. Patients often present to a veterinary ophthalmologist for vision loss when the retina in the second eye detaches. Signs of retinal detachment include vision loss, a dilated pupil, increased eyeshine, and sometimes blood within the eye. With cataracts, retinal detachments are often detected during pre-operative screening ultrasounds. They may also be identified following cataract surgery during recheck examinations.

How is retinal reattachment surgery performed?

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Surgical correction is accomplished by entering the back of the eye via small ports. The diseased vitreous is first removed. The detached retina is then repositioned back against the back of the eye using a heavy oil called PFO. The PFO is replaced by silicon oil, which acts as an artificial vitreous. A laser is also used to strengthen the retina’s attachment to the back of the eye.

What is the success rate?

The two biggest factors that influence the success of surgery are: the length of time the retina has been detached prior to surgery and the cause of retinal detachment. Predisposed breeds, such as the Shih Tzu, tend to have the highest success rates (often >90%) if retinal detachments are caught early.  Retinal detachments following blunt trauma or bite wounds often have the lowest success rate (<50%). The veterinary ophthalmologist performing retinal reattachment surgery will be able to further discuss the estimated success rate for your pet, the details and care involved with retinal reattachment surgery, as well as work with your local veterinary ophthalmologist to provide long-term care for your pet’s eyes.

What are some potential post-operative complications?

The success of retinal reattachment surgery has improved over the past decade with state of the art equipment and shorter surgery times. However, complications can arise and include retinal re-detachment and degeneration, glaucoma, chronic inflammation, bleeding inside the eye, corneal ulceration, cataract formation, changes in focusing, or silicon oil migration into the front of the eye.

What if retinal reattachment surgery isn’t a possibility?

While most retinal detachments are not initially associated with discomfort, long term, many dogs with an untreated retinal detachment will develop glaucoma, or an elevated pressure in the eye. As this can become an uncomfortable condition, your pet should continue to receive ocular exams over time. Should glaucoma develop, further treatment will be necessary to maintain comfort.

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