Retinal detachment FAQ’s
What causes retinal detachment?
The retina is the nerve layer that lines the back of the eye. If you think of the eye as a camera, the retina is the film in the camera. A clear gel called the vitreous fills up the inside cavity of the eye and is located just in front of the retina. As one ages, the vitreous gel contracts and liquefies. As this occurs, the vitreous gel may sometimes pull a tear in the retina. Fluid from inside the eye can leak through the tear, and the retina can separate from the back wall of the eye, creating a retinal detachment.
Retinal detachments occur with a frequency of 1 per 10,000 people per year. It is a serious condition that may lead to blindness if not treated appropriately. Risk factors for retinal detachment include nearsightedness (myopia), history of cataract surgery, family history of retinal detachment, retinal detachment in the other eye, and weak areas in the retina such as lattice degeneration. Symptoms of a retinal detachment include onset of floaters, flashing lights, and a “curtain” or area of darkness that may encroach on vision from the side. There is no pain with retinal detachment. You should contact your eye doctor as soon as possible if any of these symptoms develop.
How can a detached retina be repaired?
Repair of a retinal detachment is accomplished by bringing the retina back into position and then sealing the hole or tear in the retina. Retinal detachment is almost always treated with some form of surgery. If the detachment is not extensive, it can be treated with laser or cryotherapy (freezing) in the office. Some detachments may also be treated with a procedure called pneumatic retinopexy. This involves the injection of air or gas into the eye in conjunction with laser or cryo. Patients are giving specific head position instructions which allows the bubble to float up against the retina and keep it in position as it heals. Pneumatic retinopexy is only suitable for a select group of retinal detachments.
One of the most common surgical techniques in retinal detachment repair is a scleral buckle procedure. This is done in the operating room where a silicone band is placed around the eye. The band changes the shape of the eye and brings the retina back into contact with the wall of the eye. Cryo or laser are used to treat around the retinal breaks and other weak areas.
Vitrectomy surgery also has a role in retinal detachment repair. With this technique, the vitreous gel and any scar tissue is removed from the eye. After the retina is reattached, the vitreous cavity is filled with a gas bubble which helps to hold the retina in position. The bubble generally lasts in the eye for several weeks and is gradually absorbed by the body. In cases of complex retinal detachment, a silicone oil bubble may be used in place of gas. Silicone oil does not dissolve on its own and a second surgery is required to remove it once the retinal tissues are stable.
Retinal detachment surgery
Surgery for most retinal detachments takes about one hour and can be done under local anesthesia. You do not have to be admitted to the hospital afterwards. Your surgeon may give you specific instructions regarding head positioning afterwards in order to maximize the chances of a successful outcome. If a gas bubble is used, there may be limitations on flying in an airplane or traveling to high altitudes. Also, if you need surgery for any other reason while a gas bubble is in the eye, it is important to notify the anesthesiologist because special considerations are required to prevent the gas bubble from expanding in the eye.
What kind of results can I expect from retinal reattachment surgery?
The visual results of retinal reattachment depend on three main factors: how long the retina has been detached, how much of the retina is detached and most importantly, whether the center of vision is involved. If the center of vision is not involved, nearly full visual recovery can often be achieved. If the center of vision is involved, there is usually some permanent loss of vision. Your prescription for glasses may also need to be changed as a result of the surgery.