Retinal Detachment

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The middle of our eye is filled with a clear gel called vitreous (vi-tree-us) that is attached to the retina. Sometimes tiny clumps of gel or cells inside the vitreous will cast shadows on the retina, and you may sometimes see small dots, specks, strings or clouds moving in your field of vision.

Retinal tear or detachment patients often complain of having floaters & flashing lights in one eye, followed by the onset of a shadow that progresses towards their central vision. Retinal tears usually occur as a result of an abnormal retinal attachment to the vitreous that rips during the development of a vitreous detachment, a normal aging event. A retinal tear can be treated with laser surgery or cryopexy. These treatments form a scar which prevents the tear from progressing into a detached retina. About 50% of untreated cases will progress into a retinal detachment.

Surgery is required to prevent permanent vision loss from retinal detachment. Presently, there are three main treatments for a detached retina, each of which has its own advantages and disadvantages:

  • Pneumatic retinopexy – an office based procedure that involves injecting a gas bubble in the eye to prevent further tearing of the retina, along with either laser or cryotherapy to close the retinal tear.
  • Scleral buckle – involves the application of a silicone band or sponge to the external surface of the eye to reduce the traction in the region of the retinal break. Cryopexy is usually applied to seal the retinal break.
  • Vitrectomy – the eye is entered through 3 ports following which the vitreous and all traction on the retinal break is removed. The retina is flattened with removal of the subretinal fluid during an air-fluid exchange. Laser treatment is applied around the retinal break. Finally, the air is often exchanged for a longer acting gas or silicone oil tamponade.

 

 

The current success of all of these procedures is excellent with the retina remaining reattached in 80-90% of cases. The visual results are frequently dependent on the duration of the detachment and whether or not the macula was detached prior to surgery. Although all patients with the onset of floaters or flashing lights requires a peripheral retinal evaluation, fortunately only about 10% will end up having a retinal tear.

Retinal Detachment: Torn or Detached Retina Symptoms

Symptoms of a retinal tear and a retinal detachment can include the following:

  • A sudden increase in size and number of floaters, indicating a retinal tear may be occurring;
  • A sudden appearance of flashes, which could be the first stage of a retinal tear or detachment;
  • Having a shadow appear in the periphery (side) of your field of vision;
  • Seeing a gray curtain moving across your field of vision;
  • A sudden decrease in your vision.

Who Is At Risk for a Torn or Detached Retina?

People with the following conditions have an increased risk for retinal detachment:

  • Nearsightedness;
  • Previous cataract surgery;
  • Glaucoma;
  • Severe eye injury;
  • Previous retinal detachment in the other eye;
  • Family history of retinal detachment;
  • Weak areas in the retina that can be seen by an ophthalmologist during an eye exam.

Retinal Detachment: Torn or Detached Retina Treatment

Torn retina surgery

Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office.

Laser surgery (photocoagulation)

With laser surgery, your Doctor may use a laser to make small burns around the retinal tear. The scarring that results seals the retina to the underlying tissue, helping to prevent a retinal detachment.

Pneumatic retinopexy

In this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done in the ophthalmologist’s office. Your ophthalmologist will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear.

 

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