Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium. The sings of retinal detachment are decreased peripheral or central vision, often described as a curtain or dark cloud coming across the field of vision.
Retinal detachment requires emergency treatment. The longer it goes untreated, the higher the risk of permanent vision loss in the affected eye.
Retinal detachment is painless. Early symptoms of the disease include sudden increase of floaters, flashes of light, and blurred vision. As detachment progresses, patients often notice a gray curtain in the field of vision.
When to see a doctor
You should immediately see a doctor if you are experiencing the signs or symptoms of retinal detachment. Retinal detachment is a medical emergency in which you can permanently lose your vision.
- Rhegmatogenous detachment
This type of retinal detachment is caused by a retinal break that allows fluid to pass through and collect underneath the retina, pulling the retina away from underlying tissues. The areas where the retina detaches lose their blood supply and stop working, leading to loss vision.
The most common cause of retinal breaks is changes in vitreous that occur with aging. As a result of those changes, vitreous separates from the surface of the retina and may tug on the retina with enough force to create a retinal break.
- Tractional detachment
Tractional retinal detachment can occur when scar tissue grows on the surface of the retina that force the retina to separate from the underlying retinal pigment epithelium. Tractional retinal detachment is usually a complication of diabetes.
- Exudative detachment.
In this type of retinal detachment, fluid accumulates beneath the retina in which there are no breaks. Exudative detachment can be caused by age-related macular degeneration, injury to the eye, tumors or inflammatory disorders.
- Previous retinal detachment
- Previous cataract surgery
- Family history of retinal detachment
- High myopia
- Ocular trauma
- Lattice retinal degeneration
Retinal detachment can be diagnosed with ophthalmoscopy. It’s a test that makes possible to see the fundus of the eye. Ophthalmoscopy shows the retinal detachment and can differentiate the subtypes of retinal detachment in nearly all cases.
If vitreous hemorrhage (which may be due to a retinal tear), cataract, corneal opacification, or traumatic injury obscures the retina, retinal detachment should be suspected and B-scan ultrasonography should be done.
Regardless of the surgical technique chosen, the surgical goals are to identify and close all the retinal breaks. Closure of the breaks occurs when the edges of the retinal break are brought into contact with the underlying retinal pigment epithelium.
Local sealing the retinal breaks by laser photocoagulation is performed in fresh retinal detachment. The laser impact leads to sharp increase of the temperature causing coagulation of the tissue and creating a scar. This scar tissue helps seal the tear or reattach a detached area to the retinal pigment epithelium.
In some cases, surgical treatment of retinal detachment involves pars plana vitrectomy. Vitrectomy is eye surgery to remove the vitreous, which is performed both for the treatment of vitreous haemorrage and in order to provide the vitreoretinal surgeon with access to the retina.
Initially, pars plana vitrectomy was reserved for complicated retinal detachments, such as giant retinal breaks and diabetic tractional detachments. Currently, many surgeons use it to treat primary uncomplicated retinal detachments.
During vitrectomy the surgeon removes the vitreous from the margins of the breaks using a 3-port approach with 23, 25 or 27-gauge instrumentation. Treatment of retinal breaks may be completed with laser after the retina is attached.
Intraocular tamponade with either long-acting gas or silicone oil is chosen according to the surgeon’s preference. The advantages of gas are that it has a higher surface tension than silicone oil and it disappears on its own. The disadvantage is that it expands with changing atmospheric pressure. Patients with an intraocular gas bubble should not fly. On the other hand, silicone oil allows patients to fly but needs to be removed in a second procedure because of its inherent toxicity.
Each procedure should be selected on a case-by-case basis and depends on the period of time that has elapsed from occurrence of detachment, how many breaks the retina has, where they are located, etc. The treatment may be carried out in one or more stages, depending on the case.