What is Retinal Detachment?
The retina is a transparent neurosensorial tissue that lines the back of the eyeball.
Retinal detachment is a condition in which the neurosensory retina is separated from the retinal pigment epithelium. It is considered a medical emergency because, if not treated promptly, it can lead to permanent loss of vision.
What can suffer a retinal detachment?
It can happen to people of all ages, although there are certain factors considered risky, such as: high myopia; previous intraocular surgeries; eye trauma, having had a retinal detachment in the other eye, or a family history of retinal detachment.
Causes of retinal detachment
Types of retinal detachment include rhegmatogenous, exudative, tractional, combined tractional-rhegmatogenous, and macular hole–associated detachment. Rhegmatogenous retinal detachment is the most common of these.
Rhegmatogenous retinal detachment is related to a tear or rupture of the retina. Through this break, fluids from inside the eye can enter under the retina, causing a separation of the retina from the underlying tissues.
Tractional retinal detachment is caused by traction inside the eye, as, for example, in patients with very advanced diabetic retinopathy.
Macular hole–associated retinal detachment occurs as a consequence of a macular hole.
Symptoms
The most frequent and characteristic symptom is the presence of a “dark curtain” in the field of vision. If the macula (the area located in the center of the retina responsible for “fine and detailed” vision) is affected, there will be a visual acuity reduction. Although the sight of small black dots, called “floaters” is very common in normal eyes, the sudden appearance of multiple floaters can suggest a retinal detachment. Another suggestive symptom of retinal detachment is the appearance of “light flashes”. Finally, retinal detachment can appear as a shadow in peripheral (side) vision.
There is usually no pain in or around the eye.
Diagnosis
If you have any of the aforementioned symptoms, it is essential that you go to your ophthalmologist as soon as possible, since retinal detachment is a medical emergency. An ophthalmological examination should be performed that includes visual acuity (far and near), measurement of intraocular pressure, study of the structures of the anterior part of the eye and examination of the fundus. In those patients who present intraocular bleeding that makes it impossible to visualize the fundus, an ultrasound study is indicated.
Treatment
Most people with a retinal detachment need surgery, which must be done in a short period of time.
If the presence of tears or breaks in the retina is diagnosed, before the detachment occurs, a laser treatment may be performed to seal the tear (treatment for prophylactic purposes).
In case of presenting a “small” retinal detachment (it could be said limited), a Pneumatic Retinopexy (injection of a gas bubble inside the eyeball, which applies the retina so that it can heal) can be performed. Subsequently, a treatment with laser to seal the tear Gas is gradually eliminated.
The most serious retinal detachments require a surgical intervention, which in most cases is performed under local anesthesia and on an outpatient basis, although these circumstances may vary depending on the characteristics of the patient.
Today, there are different surgical interventions for the treatment of retinal detachment. The most appropriate technique will be determined by the retina specialist ophthalmologist. The most commonly used today are:
- Scleral explant: A silicone band is sutured into the sclera, on the outside of the eyeball. This gently presses the eye inward, helping the detached retina seal against the eye wall. Cold treatment (cryotherapy) is usually applied to seal the retinal tear. The scleral band is hidden under the conjunctiva and, as a general rule, is left permanently in the eye.
- Vitrectomy: The vitreous humor (a transparent substance, similar to gelatin, that fills the eyeball) is removed. The vitreous will be replaced by a bubble of air, gas, or silicone oil. Both air and gas will disappear spontaneously days or weeks after surgery, depending on each case, being progressively replaced by the fluid normally produced by the eye (aqueous humor). Silicone oil is not spontaneously reabsorbed and requires a subsequent intervention (months later) to remove it. The use of silicone oil is usually reserved for the most complex and serious cases.
Prognosis
The prognosis after a retinal detachment depends on the location and magnitude of the detachment, as well as the treatment performed and its promptness. If the macula was not damaged, the prognosis after treatment can be excellent.
However, like any type of surgery, it is not without potential complications, such as the appearance of a cataract, an eye infection, increased intraocular pressure or the appearance of intraocular bleeding.
It is important to mention that, although it is possible to resolve the detachment in approximately 90% of patients, successful retinal repair does not always restore vision completely and even some retinal detachments cannot be repaired.
Postoperative recommendations
- You may feel some discomfort (gritty sensation) for a few days or weeks after surgery. These annoyances will gradually diminish.
- You should reduce your physical activity after surgery. Depending on your evolution, your ophthalmologist will tell you when you can resume activities (driving, exercising, etc.).
- If a bubble has been placed in the eye, the head should be held in a specific position (indicated by the ophthalmologist) for a period of time, for example 1–2 weeks.
- Air travel is not recommended until the gas bubble has been reabsorbed.
Vision should start to improve about four to six weeks after surgery. Visual recovery will depend on the damage the detachment has caused to the cells of the retina.
