RETINA CLINIC

What is retinal detachment?

Retinal detachment means that the retina separates (detaches) from the back of the eye. In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment. This detached part will not work properly causing blurring or blind spots in vision. It requires urgent treatment before vision is permanently affected. If not promptly treated, retinal detachment can cause permanent vision loss.

 

What causes the retina to detach?

Most retinal detachments are preceded by a hole or tear in the retina. This may occur when the retina becomes 'thin', due to ageing or more often if the vitreous (the jelly-like substance that fills the eye) shrinks from the retina. Fluid then collects behind the retina, separating it from the back of the eye.

 

Which people are more at risk for retinal detachment?

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women. A retinal detachment is also more likely to occur in people who:

  • Are extremely nearsighted
  • Have had a retinal detachment in the other eye
  • Have a family history of retinal detachment
  • Have had cataract surgery
  • Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
  • Have had an eye injury
 

What are the symptoms of retinal detachment?

Retinal detachment usually causes partial or total loss of vision in that eye.

Symptoms include a sudden appearance or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. The sudden appearance of floaters or flashes of light is a warning that the eye must be immediately and thoroughly examined to rule out retinal problems such as tears. The earlier these are diagnosed, the more easily can they be treated.

Sometimes the patient may not notice floaters or light flashes, but a "wavy" vision, or a dark spot in some part of their vision.

Another symptom is the appearance of a curtain over the field of vision.

Sometimes there is sudden total loss of vision in one eye.

A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

 

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Rhegmatogenous: A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional: In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common. It occurs secondary to problems like diabetic retinopathy and vein occlusions.

Exudative: Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

 

How is retinal detachment treated?

Surgery of some sort needs to be performed as early as possible if better results are to be achieved. Your eye surgeon will be able to decide which treatment is best for you depending n the severity of the detachment. The retinal tear must be sealed and the retina must be reattached and prevented from further detachment.

If there is a hole or a tear, the aim is to seal the retina around the tear so as to prevent fluid collecting behind the tear and producing a detachment. This is usually done by laser photocoagulation or a freeze treatment called cryotherapy. The laser is used to produce tiny burns around the tear, resulting in scars that will seal the edges of the tear and prevent fluid collecting behind it - the retina is "welded" back into place. Cryopexy is the term used to freeze the wall of the eye behind the tear - again the scar so formed will seal the edges of the tear. Both these techniques can be done as out-patient procedures, and do not involve any incision, suturing etc .i.e. they are applied from outside the eye.

If there is a detachment, you may require admission and general anaesthesia as the surgery is more complex. The surgery aims to press and hold the back of the eye against the retinal holes until scar formation seals up the tears. Fluid may need to be drained from behind the retina before it can settle back onto the wall. One often needs to place a scleral buckle, a silicone band or pad on the outside of the eyeball to push the wall of the eye against the retinal hole. At the same time laser or cryo is also used to seal the tear. If necessary, a vitrectomy may also be performed.

In more complicated detachments, vitrectomy may be necessary. Here the shrunken vitreous body is removed and replaced with air, gas or silicon oil. This will push the retina back onto the wall from inside the eye. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place. Often the surgeon might prefer to inject silicone oil into the eye so that long term support to the retina is obtained. This silicone oil, of course, needs to be removed later.

After surgery, normal activities can be resumed. If necessary, you will be advised by your doctor to maintain certain positions - posturing- after the surgery.

 

How successful is the treatment?

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

 

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About Shiv Jyoti

In Ahmedabad, Shiv Jyoti Eye Hospital is a recognized name in patient care. It was incepted in the year 1996. They are one of the well-known Eye Hospitals in Bapunagar. Backed with a vision to offer the best in patient care and equipped with technologically advanced healthcare facilities, they are one of the upcoming names in the healthcare industry. Located in, this hospital is easily accessible by various means of transport.

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