RETINAL DETACHMENT

The retina is the innermost layer of the eye that receives and transmits images that have passed through and been focused by the lens and cornea. The retina, like a film in a camera, is responsible for creating the images that one sees. When the retina detaches, it is lifted or pulled away from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

WHAT ARE THE SYMPTOMS OF RETINAL DETACHMENT?

  • The sudden onset of light flashes and floaters.
  • A slow enlarging of a dark curtain or shadow, usually beginning in the periphery and slowly moving to central vision, could signify the start of detachment.

WHO IS AT A RISK FOR RETINAL DETACHMENT?

  • People with high minus number (Myopia).
  • People with family history of retinal detachment.
  • People with history of eye injury.
  • People with thinning of the retina (lattice degeneration) or other degenerative retinal conditions.

WHAT ARE THE TREATMENT OPTIONS FOR RETINAL DETACHMENT?

Treatment is aimed at closing retinal tears so as to facilitate reattachment of the retina. If detected early retinal holes can be sealed by Laser.Since the retina gets most of its blood supply from vessels in the wall of the eye, if it becomes detached, it does not get enough oxygen and cells in the retina suffer and begin to die. Hence prompt treatment is important.

There are different surgical procedures which repairs a detached retina, which is a separation of the retina from its normal position lining the back of the eye.

1. PNEUMATIC RETINOPEXY

The retina is reattached by injection of expansile gas into the vitreous cavity (a procedure that can be performed under local anesthesia as an office procedure or in the operation theater) followed by careful positioning of the head.

Once the retina is reattached, the retinal tear can be sealed by laser photocoagulation or cryotherapy (this can be done prior to gas injection).

Pneumatic Retinopaxy

 

2. SCLERAL BUCKLE

This surgery is generally performed in the operating room.

A piece of silicone elastic plastic or sponge is sewn onto the outer wall of the eyeball (sclera) to create an indentation or buckle effect inside the eye.

The buckle is positioned so that it pushes in on the retina, effectively closing the break. This buckle counteracts the forces that are pulling the retina away from its normal position, and it is meant to stay in place forever.

 
Scleral Buckle

 

3. VIRECTOMY

In more complicated forms of retinal detachments, Vitrectomy surgery may be necessary. The vitreous jelly is removed, as well as any scar tissue or blood which may have accumulated. The vitreous is then replaced with special fluid or a gas bubble.

WHY DO WE NEED TO DO EARLY SURGERY?

The urgency of the surgery depends on the location of the detachment. If the detachment has not affected the central vision area called the macula, surgery should be done quickly, usually the same day. This is necessary to prevent more of the retina from peeling away.

If the macula detaches, the surgery can still be done, but the visual result will not be as good. If the macula has already detached, there is less urgency. Physicians can wait a week to 10 days to schedule surgery.

WHAT ARE CHANCES OF VISUAL RECOVERY FOLLOWING RETINAL DETACHMENT SURGERY?

Approximately 90% of common retinal detachments can be initially repaired with one or a combination of above procedures. Improvement of vision in the operated eye takes weeks to months. Blurred vision is to be expected for a period of time.

About 10 to 15% of patients with retinal detachment will require repeat surgery.

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