Retinal Detachment

Retinal Detachment

Retinal detachment is usually caused by a retinal break, either a tear or a hoe. These typically develop after the collapse of the virteous body, a transparent gel at the back of the eye. This results in fluid flowing through the break under the retina and detaching it. Retinal breaks are more commonly found in myopic patients (shortsighted patients). Since the retina is in nead of nutrients and oxygen from the underlying layer, the retinal cells are severly damaged during a retinal detachment. Therefore, a retinal detachment should be treated urgently.

Symptoms

Typical symptoms of a beginning detachment is sudden onset of numerous floaters (grey of black floating dots), flashes of light and the appearance of a grey or black "curtain" impeding the visual field. Should you experience any of these symptoms, you should be seen by an ophthalmologis on the same day. If a break is detected early and the retina is still attached, laser treatment may suffice. Once the retinal is detached, surgical treatment is needed. 

Surgery

There are 2 surgical options for treating a retinal detachement:

Vitrectomy

Nowadays, we most commonly use as the surgery of choice for retinal detachments. The vitreous body, that has caused the retinal break, is removed. This type of surgery is usually perfomed under local anaesthesia but may also be performed using general anaesthesia if the patient wishes.

During surgery, the vitreous body is removed through 3 small openings. Then, the retinal break is treated either with laser or local freezing (cryopexy) resulting in local scarring. which seals the break. Thereafter, a gas bubble or in some cases silicone oil is injected into the eye at the end of surgery, depending on the size and localisation of the break. After surgery, the patient needs to stay in a special position, usually face-down, for the duration of 2-3 days in order to help the scarring process. The gas bubble will decrease in size over the next few weeks, depending on the gas mixture used during surgery. As long as the bubble is still in the eye, visual acuity is poor and the patient should not undertake any airline flights. If silicone oil was used, it will typically be removed after 3-6 months, but in some cases may be left in the eye permanenty.

A side effect of vitrectomy is the development of a clouding of the lens, called cataract. This usually develops within several months up to few years after surgery. Cataract can be treated effectively with cataract surgery.

Buckle Surgery

This method of surgery used to be the predominant method until 10-20 years ago, but in the meantime has been mostly replaced by the above mentioned vitrectomy. Buckle surgery is typically performed under general anaesthesia. A small silicone sponge is sutured onto the sclera. Sometimes, an encircling band needs to be wrapped around the eye ball. These result in a localized indent of the sclera at the sight of the retinal break to relieve the tension of the viteous gel. Then, a localized freezing (cryopexy) is performed through the sclera to induce scarring at the sight of the break. In some cases, the fluid under the retina needs to be drained through a small opening in the sclera. 

Prognosis

The probability of a permanent sealing of the retinal break and an attached retina with the first operation is approximately 85%. With additional surgery, most cases (approximately 97%) can be attached. Prognosis concerning visual acuity after surgery is strongly dependent on whether the centre of the retina (macula) was detached or not. Patients with a complete retinal detachment have a worse prognosis, especially in cases with a long standing detachment and inflammatory signs.

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