Retinal Detachment
Introduction
A torn or detached retina is a serious vision threatening problem; one that no doubt causes alarm and concern to both the patient and their family. Fortunately, with modern surgical techniques, over 90% of retinal detachments can be repaired and blindness will be prevented. Almost all of our patients return to a normal life, self-reliant, active and independent. We have prepared this site to familiarize you with retinal detachments. If you have any questions after reading this site, please feel free to talk to one of our staff.
What is a detached retina?
The retina is a thin layer of tissue that lines the inside wall of the eye, much like wallpaper covers a wall. Light enters the eye through the cornea, travels past the iris and is focused by the lens on the retina. These focused images are then sent to the brain so that vision can occur. Directly in front of the retina is the vitreous gel which fills the center of the eye. Just behind the retina are the choroid and sclera, layers that nourish and support the retina. In a retinal detachment, fluid from the vitreous gel gains access to the area underneath the retina through a hole in the retina. This "detached retina" no longer "sees."
Changes due to aging, disease, or a sudden blow to the eye all can cause retinal detachment. Most cases, however, occur because of age related changes occurring in the eye and the vitreous gel.
As the vitreous gel changes with age it shrinks and pulls away from the retina. If it pulls hard enough a tear or hole can occur. Almost all retinal detachments begin with such a tear or tears. The patient may notice flashing lights or floating spots. These are symptoms of the vitreous pulling on the retina. When the vitreous fluid passes through a tear a retinal detachment occurs.
The tear usually occurs at the edge of the retina, the periphery, and the detachment moves inward toward the center. That is why most people first notice a change in their side vision, often described as a curtain partially closed over the eye. When the detachment reaches the center vision area, central or reading vision is lost. This may happen during the first day or any time thereafter. Ideally, we would like to preserve reading vision, but this is not always possible. The degree of visual loss after successful reattachment surgery depends, in large part, on how long the retina has been detached. That is why timely treatment is of the utmost importance.
Changes due to aging, disease, or a sudden blow to the eye all can cause retinal detachment. Most cases, however, occur because of age related changes occurring in the eye and the vitreous gel.
As the vitreous gel changes with age it shrinks and pulls away from the retina. If it pulls hard enough a tear or hole can occur. Almost all retinal detachments begin with such a tear or tears. The patient may notice flashing lights or floating spots. These are symptoms of the vitreous pulling on the retina. When the vitreous fluid passes through a tear a retinal detachment occurs.
The tear usually occurs at the edge of the retina, the periphery, and the detachment moves inward toward the center. That is why most people first notice a change in their side vision, often described as a curtain partially closed over the eye. When the detachment reaches the center vision area, central or reading vision is lost. This may happen during the first day or any time thereafter. Ideally, we would like to preserve reading vision, but this is not always possible. The degree of visual loss after successful reattachment surgery depends, in large part, on how long the retina has been detached. That is why timely treatment is of the utmost importance.
Treatment
Treating retinal detachment is a two step process. First the surgeon must seal the retinal tear or tears. The retina must then be placed back into contact with the choroid so that a new bond can form to seal the retina in place.
The retinal tears are sealed using either of two techniques, cryotherapy or laser photocoagulation. In either technique, one using extreme cold (cryotherapy), the other using a bright light to create burns (laser photocoagulation), scars are created at the edges of the tear which, after several weeks, become quite firm.
It is often necessary to drain the fluid out from under the retina at the time of surgery. Laser or freezing (cryotherapy) alone will not work if fluid is present under the retina. A silicone band or "buckle" is sewn around the eye to hold the retina in place (Figures 3A and 3B). The buckle works like the band around an old fashioned barrel, pushing on the sclera and choroid and bringing it in contact with the retina. At times two-way pressure is required to promote the best healing. Air or a special gas may be injected into the eye to force the retina against the choroid from the inside. There are also times when a retinal detachment is more complex and a second technique called vitrectomy is used. In this operation small instruments are placed into the jelly cavity of the eye to remove scar tissue and blood.
After surgery the scleral buckle remains around the eye permanently. The air or gas is gradually absorbed into the body and disappears.
The retinal tears are sealed using either of two techniques, cryotherapy or laser photocoagulation. In either technique, one using extreme cold (cryotherapy), the other using a bright light to create burns (laser photocoagulation), scars are created at the edges of the tear which, after several weeks, become quite firm.
It is often necessary to drain the fluid out from under the retina at the time of surgery. Laser or freezing (cryotherapy) alone will not work if fluid is present under the retina. A silicone band or "buckle" is sewn around the eye to hold the retina in place (Figures 3A and 3B). The buckle works like the band around an old fashioned barrel, pushing on the sclera and choroid and bringing it in contact with the retina. At times two-way pressure is required to promote the best healing. Air or a special gas may be injected into the eye to force the retina against the choroid from the inside. There are also times when a retinal detachment is more complex and a second technique called vitrectomy is used. In this operation small instruments are placed into the jelly cavity of the eye to remove scar tissue and blood.
After surgery the scleral buckle remains around the eye permanently. The air or gas is gradually absorbed into the body and disappears.
What to expect
Prior to admission to the hospital we will ask you to use eye drops to dilate your pupils. A general physical checkup is required and often a chest x-ray, electrocardiogram and blood and urine tests. The purpose of these tests is to alert the doctors to potential health problems and assure that anesthesia will not cause problems. Surgery will take 2 to 4 hours. Just prior to surgery you will be given a general anesthetic in your arm or hand. This anesthetic takes effect quickly and is practically painless. Most patients describe the experience as drifting off to sleep. In some cases only a local anesthetic is used and the patient is awake during the surgery but feels no pain. This decision will be made by you and your doctors before surgery.
Following surgery you will be moved to the recovery room where specialists will monitor your vital signs. There should be little or no pain. Some patients may be able to go home the same day of surgery, others may stay in the hospital one or more days. After surgery the eye will be patched for one or two days and drops will need to be administered 3 times during the day. Those patients who require an air or gas injection into the eye will be asked to maintain a fixed head position for a number of days until the air or gas has been absorbed by the body. However, in just about all cases, patients will be able to be up and out of bed the day after surgery.
The vision will probably remain blurred for several weeks. This is normal and it may take several months before the vision stabilizes. You will be encouraged to begin using the eye shortly after surgery, however it will tire quickly. Reading, writing, and watching TV are OK, but your eye will need rest frequently. There will be some scratchy sensation from the sutures that are used during surgery. They may rub on the inside of your lids for awhile and your eye may water and burn but you should NOT touch or rub your eye.
Following surgery you will be moved to the recovery room where specialists will monitor your vital signs. There should be little or no pain. Some patients may be able to go home the same day of surgery, others may stay in the hospital one or more days. After surgery the eye will be patched for one or two days and drops will need to be administered 3 times during the day. Those patients who require an air or gas injection into the eye will be asked to maintain a fixed head position for a number of days until the air or gas has been absorbed by the body. However, in just about all cases, patients will be able to be up and out of bed the day after surgery.
The vision will probably remain blurred for several weeks. This is normal and it may take several months before the vision stabilizes. You will be encouraged to begin using the eye shortly after surgery, however it will tire quickly. Reading, writing, and watching TV are OK, but your eye will need rest frequently. There will be some scratchy sensation from the sutures that are used during surgery. They may rub on the inside of your lids for awhile and your eye may water and burn but you should NOT touch or rub your eye.
Returning home
When you leave the hospital you will be given eye drops and told how to use them. An appointment will also be made for you to return to our office for postoperative follow-up. The routine you followed in the hospital will be followed also when you return home. You can resume washing your hair in the shower about 2 weeks after surgery. You may gradually resume all normal activities but you should avoid sudden movement, strenuous activity or active sports for about 2 months. In general you may resume desk work when reading is comfortable, but strenuous physical labor must be delayed.
Will it happen again?
Recurrence of retinal detachment is rare. In about 10% of cases scar tissue may form inside the eye and pull the retina back off. A second operation is often successful in repairing this situation. There is some small risk of retinal detachment occurring in your other eye in the future. We will often treat the other eye with freezing therapy to strengthen weak areas and decrease the risk for retinal detachment.
Follow-up examinations
Your referring eye doctor should continue to serve your eye health needs including corrections in glasses or contact lenses. Your vision must return to an adequate level for sufficient correction before any changes should be made in your lens prescription. This usually takes approximately 3 months.