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What is the retina?
The retina is the nerve layer that lines the back of the
eye and forms the optic nerve. If you think of the eye
as a camera, the retina is the film in the camera. In
front of the retina is a gel that is about the
consistency of egg white.
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Retinal
Detachment |
What is retinal
detachment?
As one ages, the gel contracts and changes. It is common
for the gel to separate from the back of the eye causing
traction or pulling on the retina. Occasionally, the
traction from the gel causes a tear in the retina. Fluid
can leak through the tear, and the retina can peel away
from the back of the eye. The process of peeling away is
called a retinal detachment. Retinal detachment is a
true separation of the retina from the back of the eye.
It is occurs with a frequency of 1 per 10,000 per year.
It is a serious condition which may lead to blindness if
not treated appropriately. A retinal detachment is
generally an unstable condition which leads to
progressive loss of vision. Retinal detachment is
usually treated surgically.
What causes retinal
detachment?
Three conditions must be present for a retinal
detachment to occur-there must be a hole in the retina,
the vitreous gel which fills the eye must be liquefied,
and something must pull the retina from the back of the
eye. Retinal holes may occur in 5-10% of the normal
population. As part of the aging process the vitreous
gel liquefies and separates from the retina. In some
individuals the vitreous remains attached to the retina,
causing liquid vitreous to pass through the retinal
hole, and results in retinal detachment. The following
conditions increase your risk of having a retinal
detachment:
- Nearsightedness
- Cataract surgery
- Family history of retinal detachment
- Retinal detachment in the other eye
- Weak areas in the
retina such as lattice degeneration
What are the symptoms
of retinal detachment?
Detachment usually follows the onset of floaters,
particularly a shower of new floaters. Flashing lights
may also occur, particularly in the dark. The presence
of a curtain or loss of vision from the side usually
indicates that a detachment is present. There is no pain
associated with detachment. Should these symptoms occur,
you should contact your eye doctor as soon as possible.
What is the treatment
of retinal detachment?
Repair of a retinal detachment is accomplished by
bringing the retina back into position and then sealing
the hole or tear in the retina. Retinal detachment is
almost always treated with some form of surgery. If the
detachment is not extensive, it could be treated with
laser or cryo (freezing). These procedures can be
performed in the office. Detachments may also be treated
with a procedure called pneumatic retinopexy which
involves the injection of air or gas into the eye in
conjunction with laser or cryo. By positioning the head,
the bubble of gas presses the retina into place until
the laser or cryo closes the hole in the retina.
Pneumatic retinopexy is only suitable for a minority of
retinal detachments.
The retina can also be
repaired by using a scleral buckle procedure. This is a
procedure done in the operating room where a plastic
band is placed around the eye, changing the shape of the
eye and helping to bring the layers back together. This
operation involves the placement of a silicone rubber
band around the eye together with wider pieces of
material positioned to close the hole in the retina.
Cryo or laser are used to treat retinal holes and other
weak spots in the retina. The operation is 90-95 %
successful, but must be preformed in an operating room.
It takes 45 minutes to an hour and can be performed
under local anesthesia. You do not have to be admitted
to the hospital following surgery.
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Gas
Bubble - Face Down |
In more complex retinal
detachments, a scleral buckle is combined with
vitrectomy. A vitrectomy is a microsurgical procedure to
remove the vitreous gel and scar tissue attached to the
retina which prevents the retina from reattaching. When
the vitreous is removed, it is replaced with air or a
gas designed to hold the retina in place for several
weeks. After the gas bubble dissolves, it is replaced
with body fluid. This technique is successful in 95% of
cases of detachment. After the detachment, if a gas
bubble is used, the position that the patient sleeps and
carries out his daytime activities can be important. If
a gas bubble is used, there may be limitations on flying
in an airplane or traveling to high altitudes and
general anesthesia has to be done in special ways to
prevent the bubble from expanding.
What are the results
of retinal reattachment?
The visual results of retinal reattachment depend on
three things: How long the retina has been detached, how
much of the retina is detached and most importantly,
whether the center of vision is involved. If the center
of vision is not involved, nearly full visual recovery
can be expected. If the center of vision is involved,
there is usually some permanent loss of vision. Your
prescription for glasses will need to be changed as a
result of the surgery, requiring a new prescription 6-8
weeks after the surgery.
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