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Retinal Detachment

What is retinal detachment?

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss. 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.

Retinal Detachment

Rhegmatogenous Retinal Detachment

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Causes and Risk Factors

Who is 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, and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:

Symptoms include a sudden 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. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see a retinal surgeon immediately.

How is retinal detachment treated?

Small holes and tears are treated with laser surgery or a freeze treatment called Cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Wet AMD happens when abnormal blood vessels behind the retina start to grow under the macula known as choroidal neovascular membrane (CNVM). These new blood vessels can be fragile and leak blood and fluid. The blood and fluid cause the macula to swell and damage occurs rapidly. The damage may also cause scarring of the retina.

What are the symptoms?

  • Pneumatic Retinopexy - In this retinal detachment is treated by putting gas in side the eye. Selection of patients for such operation is depend on number of breaks in retina, location of break and proliferative changes in retina. In singal superior fresh retinal detachments pneumatic retinopexy is successful in 95% patients.
  • Scleral Buckle - In this, a scleral buckle, a tiny synthetic silicon band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. Fluid under retina is drained out and if required gas is put inside the eye. Once break falls on buckle, retina gets attached. In some cases proliferative changes take place so that retina doesn’t get attached or lifts again from its place. In such cases, need to go inside the eye to reattach retina.
  • Vitrectomy - In some cases, proliferative changes are more or re-detachment of retina after sclera buckle occurs; vitrectomy is required to put retina into its place. During a vitrectomy, a tiny incision in the sclera (white of the eye) is made and 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. Sometimes retina is very stiff and requires longer tamponade like silicon oil to keep it into its place. Once oil is put in the eye, it needs to be removed once retina gets attached.

In 90%- 95% patients retina gets attached and vision improves. But in 5 %- 10% patients develop re- detachment. In such cases resurgery is required. Resurgery success rate depends on retinal condition, amount of proliferative changes, and timing of resurgery. Success of retinal surgery is count on reattachment of retina and not on recovery of vision.

What is visual prognosis in retinal detachment treated?

Visual recovery is depending on reattachment of retina and improvement in macular condition (central portion of retina). Recovery can take time from weeks to months and can be partial to full recovery. The main aim of treatment is to reattach retina into its place.

What is follow up criteria in retinal detachment treated patients?

In retinal detachment treated patients after successful reattachment of retina every 3 month follow up for check up of same and fellow eye for at least one year. After that as per doctor’s suggestion follow up should be done.

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