Retinal Detachment Surgery:
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What is Retinal Detachment?
The retina is a thin, transparent tissue of light-sensitive nerve fibers and cells. It covers the inside wall of the eye the same as wallpaper covers the walls of a room.
Most retinal detachments are caused by the presence of one or more small tears or holes in the retina. Normal aging can sometimes cause the retina to thin and deteriorate, but more often shrinkage of the vitreous body, the clear gel-like substance which fills the center of the eye, is responsible for deterioration and retinal tears.
The vitreous is firmly attached to the retina in several places around the back wall of the eye. As the vitreous shrinks, it may pull a piece of the retina away with it, leaving a tear or hole in the retina.
Though some shrinkage of the vitreous body occurs naturally with aging and usually causes no damage to the retina, abnormal growth of the eye (sometimes a result of nearsightedness), inflammation or injury, may also cause the vitreous to shrink. In most cases, a significant change in the structure of the vitreous body occurs before the development of a retinal detachment.
Once a retinal tear is present, watery fluid from the vitreous space may pass through the hole and flow between the retina and the back wall of the eye. This separates the retina from the back of the eye and causes it to "detach." The part of the retina that is detached will not work properly and there will be a blindspot in vision.
Signs and Symptoms
The typical signs and symptoms for a retinal detachment are as follows:
The most common symptom is a shadow spreading across the vision of one eye. You may also experience bright flashes of light and/or showers of dark spots called floaters. These symptoms are never painful.
Vision loss can progress rapidly. Untreated, retinal detachment usually causes permanent blindness.
"Flashes and floaters". The sudden awareness of bright light spots or streaks and dark moving specks are due to the vitreous traction on the retinal (light flashes) and solid vitreous material or blood (floaters). Note that flashes and floaters can also commonly occur from simple causes, without retinal tears or detachment.
- Partial loss of vision. Retinal detachments can also proceed unnoticed until a large section of the retina is detached, at which time you may notice that part of your sight is missing (the missing sight could be vision loss from above, below or off to one side). It is sometimes described as a veil, curtain or shade covering a part of the vision.
Causes & Risk Factors
Retinal detachment will affect about one out of 10,000 people each year in the U.S. It is a serious eye problem that may occur at any age, though usually it occurs in middle-aged or older individuals.
It is more likely to develop in people who are nearsighted, or whose relatives had retinal detachments. A hard, solid blow to the eye may also cause the retina to detach. Severe trauma to the eye, such as a contusion or a penetrating wound, may be the cause, but in the great majority of cases, retinal detachment is the result of internal changes in the vitreous chamber associated with aging, or less frequently, with inflammation of the interior of the eye.
It should be noted that there are some retinal detachments that are caused by other diseases, such as tumors, severe inflammations or complications of diabetes. These so-called secondary detachments do not have holes or tears in the retina, and treatment of the disease which caused the retinal detachment is the only treatment which may allow the retina to return to its normal position
Who is at Risk for Retinal Detachment?
Retinal detachment is considered a risk for the following groups of people:
- Nearsighted adults
- People who have had an eye injury or post-cataract extraction surgery
- People with a family history of retinal detachment
- Retinal detachment may also be spontaneous. This occurs more often in the elderly or in very nearsighted people.
There are numerous approaches to treating retinal detachment. These include:
All cases of retinal detachment should be referred to an ophthalmologist as soon as possible.
Laser (thermal) or freezing (cryopexy)
Both of these approaches can repair a detached retina if it is diagnosed early enough.
- Pneumatic retinopexy
This procedure can be used to treat retinal detachment if the tear is small and easy to close. A small gas bubble is injected into the vitreous where it then rises and presses against the retina, closing the tear. A laser or cryopexy can then be used to seal the tear. This procedure is 85% successful.
- Scleral buckle
This treatment for retinal detachment involves placing a silicone band (buckle)around the eye to hold the retina in place. This band is not visible and remains permanently attached. Thermal treatment may then be necessary to close the tear. This procedure is effective as high as 95% of the time.
This procedure for retinal detachment is used for large tears. During a vitrectomy the vitreous is removed from the eye and replaced with a saline solution. It has similar success rates to the scleral buckle.
If the retina is torn and retinal detachment has not yet occurred, a detachment may be prevented by prompt treatment. Treatment is aimed at closing retinal tears (so as to facilitate reattachment of the retina). Once the retina becomes detached, it must be repaired surgically.
Certain types of uncomplicated retinal detachment are now being treated by the technique of pneumatic retinopexy. The retina is reattached by injection of expansile gas into the vitreous cavity (a procedure that can be performed under local anesthesia as an office procedure) followed by careful positioning of the head. Once the retina is reattached, the retinal tear can be sealed by laser photocoagulation or cryotherapy. Occasionally, removal of vitreous and internal tamponade of the retina with air, expansile gases or even silicone oil, is necessary.
About 80 percent of all uncomplicated cases can be cured with one operation; an additional 15 percent will need repeated operations and the remainder will never reattach. The prognosis is worse if the macula is detached or if the detachment is of long duration.
Without treatment, retinal detachment often becomes total within six (6) months. Unfortunately, due to continual shrinkage of the vitreous and the development of fibrous growths on the retina, not all retinas can be reattached. If the retina cannot be reattached, then the eye will continue to lose sight and ultimately become blind.
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