Retinal detachment is when the retina peels away from the back wall of the eye. In front of the retina, a clear gel called the vitreous fills the inside cavity of the eye. The vitreous gel liquefies as one ages and may sometimes pull a tear in the retina. The fluid can leak through the tear and cause the retina to separate from the back wall of the eye resulting in a retinal detachment. It is a serious condition that may lead to vision loss if not treated.
SIGNS AND SYMPTOMS
A retinal detachment is usually preceded by traction of the vitreous on the retina which may give rise to flashes of light and increase in the number of floaters. This may then progress to a curtain of darkness that decreases vision.
A dilated examination can usually detect a retinal detachment. If the view into the back of the eye is limited then a B-scan (ultrasound) may be needed.
There are several treatment options for retinal detachment. Cryotherapy (freezing) or laser photocoagulation is occasionally used alone to wall off a small area of retinal detachment so that the detachment does not spread. If the detachment is more extensive a pneumatic retinopexy or surgery may be required.
Pneumatic retinopexy is an in office procedure requiring an injection of a gas bubble inside the eye in conjunction with laser photocoagulation or cryotherapy. Not all patients with retinal detachments can be treated with a pneumatic retinopexy. It is an effective treatment for retinal detachments that are isolated in the upper portion of the retina and caused by tears localized to one area. The success of this procedure is dependent on patient positioning and is suitable for only a select group of patients.
Vitrectomy is a commonly used treatment for retinal detachment. It involves the removal of the vitreous gel and combined with filling the eye with either gas bubble or silicone oil. The gas bubble is gradually absorbed by the body. A vitrectomy may lead to progression of a cataract in the operated eye. In cases of complex retinal detachment, silicone oil may be used instead of gas. In cases where silicone oil is used, a second surgery will be needed to remove it in the future. While the gas bubble is present in the eye, there may be limitations on flying or traveling to high altitudes. It is also important to notify the anesthesiologist or dentist if any inhalational gas may be needed for a procedure. The visual prognosis after a retinal detachment repair depends how long the retina has been detached and if the center of the vision is involved.
Another method for treating retinal detachment is called scleral buckling. This may be performed as an isolated surgery or in combination with a vitrectomy. The sclera buckling procedure involves placing a silicone band around the eye. The band brings the retina back in contact with the wall of the eye. Cryotherapy is applied around the retinal breaks to seal them. The scleral buckle remains around the eye indefinitely and may cause a change in your eye glass prescription (myopic shift).
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