[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Eye surgery and procedures](https://durgical.com/en/ophthalmology/areas/surgery/) › Retinal detachment surgery: buckle, vitrectomy, gas and posturing # Retinal detachment surgery: buckle, vitrectomy, gas and posturing - Topic Detachments are repaired with a gas bubble, a silicone band or vitrectomy. With gas in the eye: no flying, no climbing to altitude, no nitrous oxide. Updated Nov 13, 2026 **See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/) · [Vitreous](https://durgical.com/en/anatomy/vitreous-body/) · [Sclera](https://durgical.com/en/anatomy/sclera/) ## Key points - Pneumatic retinopexy = gas in the clinic, upper break. - Scleral buckle = young phakic eye, band outside the eye. - Vitrectomy = older or pseudophakic, complex detachments. - Gas in the eye: no flying, no altitude, no nitrous oxide. - Silicone oil must be removed later. ## What it is A rhegmatogenous retinal detachment is repaired by closing the retinal breaks and holding the retina against the eye wall while laser or cryotherapy seals it. Pneumatic retinopexy injects a gas bubble in the clinic for a single upper break. A scleral buckle is a silicone band sewn to the outside of the eye that indents the wall towards the break. Pars plana vitrectomy removes the vitreous and fills the eye with gas or silicone oil; it is also the operation for tractional detachments, as in diabetes. ## Key facts - Pneumatic retinopexy: one break, or a few close together, in the upper retina; done in the clinic and needs strict head positioning. - Scleral buckle: young phakic patients without posterior vitreous detachment and retinal dialysis; it makes the eye more myopic and can cause double vision. - Vitrectomy: most detachments in older or pseudophakic eyes, giant tears, proliferative vitreoretinopathy and detachments behind vitreous haemorrhage; it speeds cataract in phakic eyes. - Gas bubbles last days (air), about two weeks (sulphur hexafluoride) or six to eight weeks (perfluoropropane). - Silicone oil is used in complex cases; it stays until a second operation removes it and can raise eye pressure. - Posturing keeps the bubble pressed against the break; the position depends on where the break is. ## In clinical practice - Gas expands as air pressure falls and when nitrous oxide diffuses into it: the eye pressure rises sharply and the central retinal artery can close, causing permanent blindness. - Altitude includes flights and road trips over high mountain passes, common in the Andes; patients often wear a wristband stating that there is gas in the eye. - While the eye is full of gas, vision is very poor; a moving horizontal line appears as the bubble shrinks. - Lying flat on the back with gas in the eye can push the lens forward and cause angle closure or cataract. ## Next step / Initial management - New flashes, floaters or a shadow after repair: same-day ophthalmology (redetachment or a new tear). - Severe pain, nausea or headache after surgery: same-day eye pressure check. - Gas in the eye: no flying, no travel to higher altitude and no nitrous oxide anaesthesia until ophthalmology confirms the gas has gone. - Before any general anaesthesia, ask about recent eye surgery with gas and tell the anaesthetist. - Support the posturing plan, including sick leave for the posturing period. ## Test yourself Think of the answer, then tap the question to see it. ## Why is nitrous oxide anaesthesia forbidden while gas is in the eye? It diffuses into the bubble and expands it, raising eye pressure and risking central retinal artery occlusion. ## A patient had vitrectomy with gas a week ago and wants to fly. What is the advice? Not until ophthalmology confirms the gas has gone, because the bubble expands at altitude. ## Which repair is typical for a young phakic myope with a detachment from small holes and no posterior vitreous detachment? A scleral buckle. ## What is the purpose of head posturing after gas surgery? To keep the floating bubble pressed against the retinal break while it seals. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ophthalmology/retinal-detachment-surgery-buckle-vitrectomy-gas-and-posturing/) ## Connections ## See it in 3D 3 The structures of Durgical's 3D anatomy where it is found. - [Retina](https://durgical.com/en/anatomy/retina/) - [Vitreous](https://durgical.com/en/anatomy/vitreous-body/) - [Sclera](https://durgical.com/en/anatomy/sclera/) ## Related 5 - [Retinal detachment: how fast to refer](https://durgical.com/en/ophthalmology/retinal-detachment-how-fast-to-refer/) - [Floaters and flashes](https://durgical.com/en/ophthalmology/floaters-and-flashes/) - [Ocular ultrasound and point-of-care scanning](https://durgical.com/en/ophthalmology/ocular-ultrasound-and-point-of-care-scanning/) - [Dilated fundus examination: when and how](https://durgical.com/en/ophthalmology/dilated-fundus-examination-when-and-how/) - [After cataract surgery: the complications the general doctor sees](https://durgical.com/en/ophthalmology/after-cataract-surgery-the-complications-the-general-doctor-sees/) ## Related conditions 5 - [Retinal detachment](https://durgical.com/en/conditions/retinal-detachment/) - [Posterior vitreous detachment](https://durgical.com/en/conditions/posterior-vitreous-detachment/) - [Macular hole](https://durgical.com/en/conditions/macular-hole/) - [Diabetic retinopathy](https://durgical.com/en/conditions/diabetic-retinopathy/) - [Central retinal artery occlusion](https://durgical.com/en/conditions/central-retinal-artery-occlusion/) ## In Pharmacology 1 - [Nitrous oxide](https://durgical.com/en/pharmacology/nitrous-oxide/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Retinal Detachment](https://www.ncbi.nlm.nih.gov/books/NBK551502/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Scleral Buckling](https://www.ncbi.nlm.nih.gov/books/NBK580486/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Vitrectomy](https://www.ncbi.nlm.nih.gov/books/NBK551668/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Agents for Vitreous Tamponade](https://www.ncbi.nlm.nih.gov/books/NBK580519/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Pneumatic Retinopexy](https://eyewiki.org/Pneumatic_Retinopexy) (EyeWiki (American Academy of Ophthalmology), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/retinal-detachment-surgery-buckle-vitrectomy-gas-and-posturing/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/retinal-detachment-surgery-buckle-vitrectomy-gas-and-posturing/