I know there have already been many posts about this so I'll try hard not to cover old ground.
I'm aphakic from congenital cataract surgery, and last October (at age 41) I had a superior-temporal retinal detachment in my right eye. It was macula-on, spotted early, fairly slowly progressing and repaired successfully with vitrectomy, laser, cryo and short-acting (SF6) gas. It has been stable since October, with no change in vision at all, which is a very pleasing outcome indeed!
However, I'm only too aware of the possibility of future detachment in that or in the other eye. I may possibly have had a PVD already in my good eye (symptoms about six years ago suggest this), which would put me at less risk of that one detaching, but my surgeon is quite rightly not wanting to assume anything about the completeness of this and is keeping close watch on this eye as it probably does about 95% of my seeing. I have amblyopia in the right eye from very late surgeries for the congenital cataract and later clouding of the posterior capsule all causing lack of early visual stimulation.
I suppose like most RD patients I have many worries about the future. Some are common to all RD patients while others are specific to me. I'm particularly concerned about silicone oil being placed in my eyes, something that may inevitably have to happen at some point in the event of any future detachments. With nystagmus as well as aphakia it could emulsify quickly, but the main thing that would worry me would be the thought of an attack of angle closure glaucoma. This sounds horrific to me, and if the pain from this is as bad and sudden as everyone seems to say it is, I'd be worried about being so incapacitated as not to even be able to get to a phone to dial emergency services! (I live alone).
Corneal damage or open-angle damage from emulsification sound horrible too, but at least give a little more time for decisions to be made. Having to worry about the possibility of a sudden angle-closure attack happening at any time if I ever had a permanent oil-fill sounds worse than worrying about the retina detaching - and I gather that even the latter can still happen anyway, with attendant pressure-related issues from forward prolapse of the oil. (This, incidentally, happened to me when my retina detached in October and may have been connected with forward movement of vitreous - the doctors didn't have time to explain it to me so I'm guessing a little - but my pressure shot up to 56. I had no pain with this, which presents the opposite worry to that above - if I can get to 56 and feel nothing untoward, I might not know when vision-threatening complications are occurring until it's too late).
I know I'm getting way ahead of myself in many ways, and none of this may ever happen, but I'm sure many other patients must ask these kinds of questions. How are patients like me typically managed (other than being told to stop worrying about things that may never happen!)? In other words, patients who are aphakic and who may, at some future stage, require oil.
With an oil-fill, would lots of extra face-down positioning (even if not instructed) help to mitigate glaucoma / cornea-related worries? I know about the iridectomy for drainage, but I also know even if it's made it can still close up. The odds must surely still be at least somewhat in favour of long-term success for the whole eye (and not just for the retina) after use of silicone oil in aphakic patients, even if there are never any guarantees. If all we were doing was staving off problems for a few years, I'm assuming all these eyes would surely just be "put out of their misery" (enucleated) early so as to enable the patient to move on with the least amount of time in severe pain, and adapt to a somewhat stable "new normal", albeit one that involving no sight (possibly in both eyes)!
Any general thoughts on this would be very much appreciated. (I know everyone's individual case is different).
One other question I had if I may (and I may ask my surgeon about this as she has actually been inside my eye and knows what the possibilities are - but I'm not seeing her now until December). Could implant of an IOL, even at this stage in my life, mitigate oil-related risks were I ever to need oil? To be absolutely clear on this, given my history, I'd never even dream of suggesting this at any time other than when surgery was going to be necessary anyway for other reasons. I suspect my capsules, if anything remains of them at all, wouldn't support a posterior lens, so I'm not sure quite what, if anything, would help in this situation.
Once again, any thoughts would be greatly appreciated. All I'm really doing here is to try and seek out general knowledge ahead of time. I have an excellent relationship with both my retinal consultant and my glaucoma consultant (who gives me yearly checkups), but a limited amount of time with both so it sometimes helps to be able to formulate the right sorts of questions to ask ahead of time.