Retinal Detachment

What is a Retinal Detachment?

A retinal detachment is a separation of the retina from the wall of the eye, which leads to progressive loss of peripheral and, eventually, central vision. The retina is the thin layer of tissue that lines the inside of the eye and acts like the film in a camera. It contains over a million neurons including specialized vision cells called photoreceptors. Left untreated, total, permanent loss of sight eventually occurs in most cases.

Causes and Associations

There are different kinds of retinal detachments: rhegmatogenous, tractional, and exudative. Rhegmatogenous retinal detachment is the most common type of retinal detachment and is caused by a defect in the retina, allowing fluid from the vitreous cavity of the eye to track under the retina and detach it from the eye wall. A retinal tear and associated detachments of the retina are usually unpredictable, spontaneous events.

Although a retinal detachment can occur due to trauma, it is usually caused by the separation of the vitreous gel from the retina. Over time as one ages, the vitreous gel liquefies, eventually collapsing upon itself and separating from the surface of the retina (posterior vitreous detachment). During or shortly after this event, a retinal tear can occur as a result of the gel pulling on the thin retinal tissue.

Risk factors for developing retinal tears and detachment include myopia (near-sightedness), particularly thin patches within the peripheral retina (lattice degeneration), family history, previous eye surgery, and trauma.

Detached Retina Symptoms

Patients with rhegmatogenous retinal detachments often notice the sudden onset of floaters (black dots or cobwebs in their vision) and/or flashing lights. A dark shadow or curtain progressing from one’s peripheral vision comes next and this corresponds to the retina detaching.

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

Prognosis

Retinal detachments often cause some degree of permanent visual field or central visual acuity loss, even after successful retinal reattachment. Final visual outcomes are best if the detachment is detected and treated before it involves the center of the retina (macula). Longstanding retinal detachments and those with associated scar tissue (proliferative vitreoretinopathy) typically have a poor visual prognosis. A change of glasses after healing from retinal detachment surgery may or may not improve the vision.

Prevention and Treatment

Getting a prompt retinal detachment diagnosis is the first step in treatment. If a retinal break or tear is detected prior to the development of a large retinal detachment, laser or cryotherapy (freezing) to the retinal tear is often successful in sealing the tear and preventing a detachment. However, once a larger retinal detachment develops, one or more of the following retinal reattachment procedures is typically necessary:

Pneumatic Retinopexy is an office-based procedure.  It involves the injection of a temporary gas bubble to close the retinal tear and  flatten (reattach) the surrounding detachment.  The gas injection is coupled with either a freezing treatment (cryotherapy) or laser photocoagulation to permanently seal the causative retinal tear.  After the procedure, patients must maintain a certain head position for about a week to ensure that the gas bubble properly closes the retinal tear until it is adequately sealed by the laser or freezing treatment.

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

Vitrectomy surgery is also performed in the operating room.  As the name implies, it involves surgical removal of the vitreous gel which, in turn, relieves the traction or pulling on the retinal tear that is causing the detachment. Like the other procedures, laser is then used to seal the retinal tears. Lastly, at the end of this surgery, the eye is filled with either gas or silicone oil.  Gas goes away slowly on its own, but oil does not. Silicone oil may be removed at a later date with another vitrectomy. The use of silicone oil is usually reserved for complex very complicated retinal detachments such as those associated with scar tissue or very large retinal tears.

Your surgeon will review the risks, benefits, and alternatives of the treatment options with you in further detail and make tailored recommendations based on the unique findings of your eye.

If you are experiencing symptoms of a possible retinal tear or detachment, find a Wills Eye Physician – Mid Atlantic Retina clinic near you today and book an appointment to meet with one of our world-renowned retinal specialists for top-quality care. Our team can work with you to ensure proper diagnostics and treatment procedures are undertaken in a timely fashion.