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Bethlehem

Retinal Detachment

A retinal detachment is a separation of the retina from the back wall of the eye, which often causes an initial loss of peripheral vision and eventually leads to loss of central vision. Retinal detachments are usually unpredictable and spontaneous. If not treated in a timely manner, permanent loss of sight may occur.

Types of Retinal Detachment

Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachment is the most common type of retinal detachment. It is caused by a hole or tear in the retina which then allows fluid from the vitreous cavity to pass through and collect under the retina. The build-up of fluid causes the retina to detach from the eye wall.

Tractional Retinal Detachment

Tractional retinal detachments occur when scar tissue develops on the surface of the retina. The scar tissue causes the retina to pull away from the eye wall. These detachments are typically seen in patients with diabetic retinopathy.

Exudative Retinal Detachment

Exudative retinal detachments occur when fluid accumulates under the retina but does not cause any holes or tears. These detachments can result from age-related macular degeneration, inflammation, tumors, or eye trauma.

Symptoms

Symptoms of retinal detachment include:

  • Sudden onset of floaters (black dots, strings, or cobwebs in vision)
  • Sudden onset of flashing lights (short arcs or bursts of light)
  • A dark shadow or curtain progressing from the peripheral vision

The rate of progression of the retinal detachment can vary from hours to weeks depending on many factors such as patient age and size, location, and the number of retinal tears.

Causes and Associations

Age is the most common cause of retinal detachment, and is more common in those age 50 years and older. The vitreous gel separates from the retinal surface with age and may pull on the retina to cause retinal tears,  resulting in a detachment.

Other potential risk factors of retinal detachment include:

  • Previous retinal detachment
  • Myopia (near-sightedness)
  • Lattice degeneration (thin patches within the peripheral retina)
  • Family history of retinal detachment
  • Previous eye surgery
  • Previous eye trauma

Testing

A comprehensive eye examination is important to assess retinal detachment, including vision testing, eye drops to dilate the pupils, and a complete examination of the front and back of the eye. It is best if a driver accompanies the patient during their eye exam as pupillary dilation may create near-vision blurring.

People with retinal detachment may undergo several tests to evaluate their condition including:

Treatment

If a retinal tear is detected early,  laser or cryopexy (a freezing treatment) is often successful in preventing a detachment. However, once a larger retinal detachment develops, pneumatic retinopexy, vitrectomy, and/or scleral buckle are recommended.

Pneumatic Retinopexy

Pneumatic Retinopexy  is an office-based procedure. It involves the injection of a temporary gas bubble to close the retinal tear and reattach the surrounding detachment. The gas injection is coupled with either cryotherapy or laser photocoagulation to permanently seal the tear.

Vitrectomy

Vitrectomy is the most common method for repairing retinal detachments. This is performed in the operating room as a day procedure, usually under local anesthesia. Small incisions are made on the eye, and instruments are inserted to remove the gel (vitreous) that is pulling on the retina. The retina is flattened, lasered into place, and a gas bubble or silicone oil is inserted to keep the retina in place. The surgeon may ask you to stay in certain positions after the surgery, including face down and looking straight down at the floor.

Scleral buckle

Scleral buckle surgery is performed in the operating room.  It consists of attaching a soft piece of silicone to the sclera (eye wall) which supports and helps to close the retinal tear. This is coupled with either cryotherapy or laser photocoagulation. A gas bubble is sometimes used to facilitate reattachment of the retina. In some cases, a scleral buckle may be combined with vitrectomy surgery.

Even after successful reattachment, retinal detachments often cause some degree of permanent visual field or central vision loss. Visual outcomes are best if the detachment is treated before it involves the macula. If the macula detaches, it is common to notice persistent distortion with objects sometimes appearing to be tilted or smaller even after a successful repair.

Longstanding retinal detachments and those with associated scar tissue (proliferative vitreoretinopathy) typically have a poorer visual prognosis. A change of glasses after healing from retinal detachment surgery may or may not improve vision.

If you have any signs or symptoms of retinal detachment, contact us today to meet with a Mid Atlantic Retina specialist. Our team can work with you to protect your vision and minimize your complications.