Patient Education - Retinal Detachment
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Retinal Detachment

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A retinal detachment is a separation of the retina from its attachments to the underlying tissue within the eye. Most retinal detachments are a result of a retinal break, hole, or tear. These retinal breaks may occur when the vitreous gel pulls loose or separates from its attachment to the retina, usually in the peripheral parts of the retina.
The vitreous is a clear gel that fills two-thirds of the inside of the eye and occupies the space in front of the retina. As the vitreous gel pulls loose, it will sometimes exert traction on the retina, and if the retina is weak, the retina will tear. Most retinal breaks are not a result of injury. Many people develop separation of the vitreous from the retina as they get older. However, only a small percentage of these vitreous separations result in retinal tears.
Once the retina has torn, liquid from the vitreous gel can then pass through the tear and accumulate behind the retina. The buildup of fluid behind the retina is what separates (detaches) the retina from the back of the eye. As more of the liquid vitreous collects behind the retina, the extent of the retinal detachment can progress and involve the entire retina, leading to a total retinal detachment. A retinal detachment almost always affects only one eye at a time. The second eye, however, must be checked thoroughly for any signs of predisposing factors that may lead to detachment in the future.

What are retinal detachment symptoms and signs?

Flashing lights and floaters may be the initial symptoms of a retinal detachment or of a retinal tear that precedes the detachment itself. Anyone who is beginning to experience these symptoms should see an eye doctor (ophthalmologist) for a retinal exam. In the exam, drops are used to dilate the patient's pupils to make a more detailed exam easier.
The flashing lights are caused by the vitreous gel pulling on the retina or a looseness of the vitreous, which allows the vitreous gel to bump against the retina. The lights are often described as resembling brief lightning streaks in the outside edges (periphery) of the eye. The floaters are caused by condensations (small solidifications) in the vitreous gel and frequently are described by patients as spots, strands, or little flies. Floaters are usually not associated with tears of the retina.
If the patient experiences a shadow or curtain that affects any part of the vision, this can indicate that a retinal tear has progressed to a detached retina. In this situation, one should immediately consult an eye doctor since time can be critical. The goal for the ophthalmologist is to make the diagnosis and treat the retinal tear or detachment before the central macular area of the retina detaches.

Which diseases of the eyes predispose to the development of a retinal detachment?

• Lattice degeneration of the retina is a type of thinning of the outside edges of the retina, which occurs in 6%-8% of the general population. The lattice degeneration, so-called because the thinned retina resembles the crisscross pattern of a lattice, often contains small holes. Lattice degeneration is more common in people with nearsightedness (myopia). This tendency to lattice degeneration occurs because myopic eyes are larger than normal eyes and, therefore, the peripheral retina is stretched more thinly. Fortunately, only about 1% of patients with lattice degeneration go on to develop a retinal detachment.
• High myopia (greater than 5 or 6 diopters of nearsightedness) increases the risk of a retinal detachment. In fact, the risk increases to 2.4% as compared to a 0.06% risk for a normal eye at 60 years of age. (Diopters are units of measurement that indicate the power of the lens to focus rays of light.) Cataract surgery or other operations of the eye can further increase this risk in those with high myopia.
• Cataract surgery, especially if the operation has complications, increases the risk of a retinal detachment.
• Trauma to the eye be it blunt or with sharp penetrating objects increases the risk for retinal detachment.
• Individuals with chronic inflammation of the eye (uveitis) are at increased risk of developing retinal detachment.

Treatment of retinal detachment

Laser treatment of retinal breaks

Retinal breaks without retinal detachment can be treated with laser or cryo (freezing machine) so that scar is formed around the break which will then be sealed before fluid gets back and detaches the retina.

Scleral Buckle Surgery for Retinal Detachments

Scleral buckle is a surgical procedure that has been used for more than 30 years. It involves the placement of silicone onto the outer wall of the eyeball to create a buckle effect inside the eye. The buckle pushes against the retinal tear or detachment, helping to push it back into a more normal position. Once the tear is sealed, the eye completes the healing process by resorbing the fluid inside the retina (the subretinal fluid).

Vitrectomy for Retinal Detachments

For certain types of retinal detachments ("traction" retinal detachments and detachments that involve the loss of the natural fluids inside the retina), vitrectomy is a commonly used surgical procedure.
Sometimes referred to as "pars plana vitrectomy or PPV," this procedure was developed about 20 years ago. Small incisions are made to allow access into the center of the eyeball. The surgeon removes the vitreous and repairs the detachment. After surgery, the patient will need to use certain precautions and maintain specific head positions to prevent another retinal detachment. Within days-to-weeks of surgery, the eye will replace its own fluids inside the retina.