What is a Retinal Detachment?
The Retina is the light sensitive membrane inside the eye, in many ways it is similar to the film in the camera. In a retinal detachment the retina peels away from the inner wall of the eye. This is usually due to development of a hole or tear through which fluid leaks.
Most people with the rest detachment are aware of a problem: there is usually a dark or missing area of vision, extending from the top bottom or side towards the middle. In some cases however, a retinal detachment can be present for many years without causing symptoms.
What happens if a Detached Retina is not treated?
If left untreated retinal detachments will usually (but not always) progress to involve most or all of the retina, with permanent loss of vision resulting. It is therefore usual to treat retinal detachments. Some detachments are however stable and can be left untreated: this is very much an expertise based case by case decision and discussion.
How urgent is retinal Detachment Surgery
Most retinal detachments are treated urgently either to prevent progression to the macula which is the very central part of the retina which provides the best quality vision being involved, or to reattach the macula soon after it becomes involved. If the retina has been detached for some time then surgery may not be urgent, the urgency therefore tends to be decided on a case by case basis.
How are Retinal Detachments Treated?
Retinal detachment treatment can involve laser to wall off the detachment and prevent it progressing, or more usually surgery to reattach the retina. The surgical options broadly divide into three groups: 1) pneumatic retinopexy in which a gas bubble is used to push the retina back into place and freezing or laser treatment applied to seal the hole or tear, 2) buckling surgery in which a silicon rubber explant is sewn to the outside of the eye to reattach the retina along with laser or freezing treatment treatment to seal the break, or 3) vitrectomy surgery in which the viscous jelly inside the eyes is surgically removed and replaced with a temporary gas or silicon oil bubble which splints the retina in place again with freezing or laser treatment applied to seal the hole or tear. The decision about which procedure is most appropriate is again made on a complex case specific assessment.
How successful is Retinal Detachment Surgery?
Overall between 85 and 90% of retinal detachments will be repaired with one operation. Unfortunately that means that 10 to 15% or between one and seven and one in ten patients with a retinal detachment will need more than one repair procedure. If silicon oil is used in an operation then it is usual to remove it. That means that patients in whom silicon oil is used will have to undergo at least two operations even if the first operation is successful. Gas bubbles usually absorb themselves so if a gas bubble is used only one operation may be needed. The choice of oil or gas is again a case complexity based decision.
What is the vision like after Retinal Detachment Surgery?
The visual outcome depends on many factors. If the central part of the retina known as the macula is not involved then the vision may return almost to normal with restoration of the outer missing part. If the macula is involved the vision will usually be impaired to a greater or lesser degree extending from almost normal to very poor. There can be both a lack of clarity and or a distorted image. It is possible to recover very good vision after a macula involved detachment if the first procedure works and the macula was only involved for a short period of time. There are however many reasons why good vision may not be recovered, these again might be explained after a complexity based assessment. What is a Retinal Detachment?
When to Seek a Second Opinion?
Retinal detachment surgery has a high success rate, but not every case is straight forward, and around one in 7 cases need more than one operation. You may benefit from a second opinion if you've been diagnosed with a retinal detachment and want to understand your options fully, if previous surgery hasn't achieved the hoped-for result, or if you're facing a complex situation where expert input could help guide decisions.
A second opinion isn't about doubting your current care—it's about ensuring you have all the information you need to make the right decision for your sight.
Areas of Specialist Expertise
Mr Laidlaw has 27 years experience in providing, teaching and researching retinal detachment surgery. He is one of the UKs best known retinal surgeons.
Redetachment & Failed Primary Surgery
When initial surgery hasn't achieved retinal reattachment, or the retina has redetached, further surgery requires careful planning and expertise.
Proliferative Vitreoretinopathy (PVR)
PVR occurs when scar tissue forms inside the eye following detachment. Managing PVR requires specialist surgical techniques.
Complex & Giant Retinal Tears
Large or unusually positioned tears, multiple breaks, or detachments in eyes with other pathology require experienced surgical judgement.
Silicone Oil Management
Decisions about silicone oil tamponade—when to use it, when to remove it, and managing eyes with long-term oil.
What to Expect from Your Consultation
Thorough review of your history, imaging and any previous surgical records
Comprehensive examination with OCT and other imaging as needed
Honest discussion of options, risks and realistic expectations
Clear recommendations—whether that's further surgery, observation, or returning to your original surgeon with confidence
The Consultation Process
Before Your Visit
Bring any scans, operation notes or correspondence. The more information available, the better the assessment.
Assessment
Detailed examination and review of your case. Time to discuss your concerns and ask questions. Scans and photographs.
Recommendations
Clear advice on the best path forward, with a written summary for you and your referring doctor if appropriate.
Why Choose Mr Laidlaw?
Mr Alistair Laidlaw is one of the UK's best known and most experienced Vitreo Retinal surgeons. In his 27 years as an NHS consultant at St Thomas' Hospital London and The Maidstone Hospital Kent he has performed and taught retinal surgery and published over 70 research papers. He has been elected President of both the British & Eire Association of Vitreo Retinal Surgeons (BEAVRS) and Euretina.
His expertise means he can provide accurate diagnosis at The London Clinic Eye Centre, 119 Harley Street, London W1G 6AU. If surgery is needed, this is performed at The London Clinic, 20 Devonshire Place, London.