Retinal Detachment

About the Retina and Vitreous

• The retina is a very thin layer of tissue that lines the inner part of the back of the eye and is continuous with the optic nerve. It contains photoreceptor cells (rods and cones), which capture the light rays that enter the eye. These light impulses are then sent to the brain for processing via the optic nerve.
• The macula is a specialized area of the retina that allows us to see detailed, central vision. This makes it possible for us to read, watch television, and recognize faces.
• The vitreous is a clear, gel-like substance that fills the center of the eye. It accounts for about two-thirds of the eye’s volume, giving it shape before birth.

Retinal Tear

• In a young, healthy eye, the retina is attached to a substance called vitreous gel. As we age, the vitreous gel inside of the eye becomes thinner and separates from the retina. This separation is called posterior vitreous detachment (PVD). PVDs typically cause eye floaters, but are otherwise relatively harmless. However, sometimes the traction caused by the detachment can create a tear in the retina. Retinal tears frequently lead to retinal detachments. If caught early, they can often be sealed with laser treatment or through cryotherapy, a procedure that uses nitrous oxide to freeze the retina and keep it in place.
• Retinal Detachment Retinal detachment occurs when the retina’s sensory and pigment layers separate. The problem is most commonly seen in the middle-aged and elderly.
• A detached retina is a serious problem that requires immediate attention from an experienced eye surgeon. Contact immediately to an opthalmologist if you are experiencing symptoms of this condition. Without immediate surgery, retinal detachment can result in devastating damage to your vision.

Types of Retinal Detachment (There are three types of retinal detachments)

• The most common type occurs when there is a break in the sensory layer of the retina and fluid seeps underneath, causing the layers of the retina to separate. Nearsighted people are more susceptible to this type of detachment because their eyes are longer than average from front to back, causing the retina to be thinner and more fragile. Patients who have undergone eye surgery or have experienced a serious eye injury are also at greater risk for this type of detachment.
• The second most common type occurs when strands of vitreous or scar tissue create traction on the retina, pulling it loose. Patients with diabetes are more likely to experience this type.
• The third type of detachment happens when fluid collects underneath the layers of the retina, causing it to separate from the back wall of the eye. This type usually occurs in conjunction with another disease affecting the eye that causes swelling or bleeding
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The following are some common signs of retinal detachment

• Light flashes
• “Wavy” or “watery” vision
• Veil or curtain obstructing vision
• Shower of floaters that resemble spots, bugs, or spider webs
• Sudden decrease of vision

If you are experiencing symptoms of a detached retina, contact an eye surgeon right away. Receiving immediate treatment increases the chance that you may regain lost vision and/or limit further loss.

When the vitreous gel rubs or pulls on the retina, you may see flashing lights or “lightning streaks”. If you notice the sudden appearance of light flashes, you should visit your ophthalmologist immediately to see if your retina has been torn.

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.

It should also be noted that ‘floaters’ are very commonly seen by people who have no eye disease. They are seen as small specks, circles, lines, clouds or cobwebs moving in one’s field of vision. They are actually tiny clumps of gel or cells inside the vitreous and cause no harm. Floaters can get in the way of clear vision, which may be annoying when you are trying to read. You can try moving your eyes; looking up and then looking down to move the floaters out of the way. While some floaters may remain in your vision, many of them will fade over time and become less bothersome. However you should visit your ophthalmologist if you suddenly notice new floaters because you need to know if your retina is torn.

Treatment

There are a number of ways to treat retinal detachment. Your retinal surgeon will determine which treatment is best for you based on the type, severity, and location of the detachment.

Pneumatic Retinopexy

In this procedure, the retina surgeon numbs the eye with local anesthesia and injects a small gas bubble into the eye’s cavity. The bubble facilitates the repositioning of the retina back into its normal location, and keeps the two detached layers up against each other. Because the gas rises, thistreatment works best for detachments in the upper portion of the eye.

Over a period of one to two weeks, the eye gradually absorbs the gas bubble. During that time, your eye surgeon will perform another procedure to “tack down” the retina. This can be accomplished with a laser or through cryotherapy.

Scleral Buckle

If you have a detached retina of a certain size and location, your retina surgeon may treat it with a scleral buckle. When this technique is used, a tiny sponge or band made of silicone is secured around the eyeball, pressing inward and holding the retina in position. It is placed beneath the eyelids so it will not be visible after surgery.

After placing the scleral buckle, your retina surgeon may perform a surgical procedure called a vitrectomy to remove the vitreous gel from the eye, and may also seal a few areas of the retina into position with laser or cryotherapy. The scleral buckle technique may elongate the eye and cause nearsightedness, which may require post-operative glasses. Reattachment with Silicone Oil

When other retinal detachment surgeries prove ineffective, silicone oil may be used to reattach the retina. To perform this procedure, the eye surgeon removes the vitreous gel and replaces it with silicone oil. Vision is extremely poor when the oil is inside of the eye. After the retina has resealed itself against the back of the eye, a second procedure is often performed to remove the oil.

Complications

Even though the surgery for retinal detachment is generally successful, certain complications can occur. They include drooping of the upper lid and double vision, which are temporary. Serious complications include infection, bleeding severe enough to interfere with vision, glaucoma and cataract formation. However, these complications are very infrequent. Retinal re-detachment is the most commonly occurring problem. If this occurs, your surgeon will discuss the chance that a re-operation will successfully re-attach the retina. It is important for the patient to know that surgery may fail due to complications, or simply due to the progressive nature of the retinal disease.