Retinal detachment
The light-sensitive layer of tissue that lines the inside of the eye is known as retina. It is the main part of the eye and its main function is to form the image and send it through the optic nerve to the brain. When retinal detachment occurs, this layer is lifted or pulled from its normal position. Retinal detachment can cause a permanent loss of vision if not treated at the right time.
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.
What are the different types of retinal detachment?
There are three different types of retinal detachment:
Rhegmatogenous – These types of retinal detachments are by far the most common. A tear or break in the retina allows fluid from in front of the retina to get under it separating it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina.
Tractional – This type of detachment is less common. Scar tissue on the surface of the retina contracts and causes the retina to separate from the RPE. It is commonly seen in diabetic retinopathy.
Exudative – Caused by retinal diseases where inflammatory or exudative fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.
What are the symptoms?
Most commonly, a patient with retinal detachment presents with a sudden, painless loss of vision like a ‘curtain rising or falling’ in front of the eye. It may be preceded by ‘floaters and flashes of light’. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more common in people over the age of 40. It affects men more than women. A retinal detachment is also more likely to occur in people who:
Are extremely myopic or nearsighted
Have a family history of retinal detachment
Have other eye diseases or disorders such as lattice degeneration, retinal holes/tears
Have a history of an eye injury
Have a history of suffering from retinal detachment in the other eye
Have a history of prior cataract surgery
Have diabetic retinopathy
How is it treated?
A retinal detachment is treated surgically. The aim of surgery is to repair the tear(s) using biological ‘adhesive’ in the form of cryotherapy or laser. The ‘biological glue’ takes several weeks to be effective so some form of splint is required to help the retina during this critical period.
Varieties of splint
External splint or Scleral buckling
In many patients the tear in the retina can be repaired using a piece of silicone sewn directly to the wall of the back of the eye producing an indent or ‘buckle’. This maintains closure of the retinal tear as healing takes place.
Internal splint or vitrectomy
In some patients, closure of the retinal tears using an external approach is not possible or appropriate. Using ‘key-hole’ instruments, the vitreous gel filling the space in front of the retina is replaced with gas or silicone oil which seal the retinal tears from the inside. If a gas is used it slowly disappears over the weeks following surgery. If the silicone oil splint is required then a second operation (Stage II) may be planned to remove the silicone oil once the retina is stable. Nowadays the whole process can be done with such fine instruments that even ‘stitches’ are not required thereby making the surgery quicker, safer and the postoperative recovery is easier and very fast.
Mixed
In some patients a combination of internal and external splints are required.
Post operative posturing
If an ‘internal’ splint of gas or silicone oil is used, you may be asked to maintain a specific posture in the early postoperative period so that your head is in a particular position. This allows the internal splint to float and support that particular part of the retina which was torn. You will be given instructions regarding the posturing position (if required) after your operation. Although it is perfectly safe to move, walk, visit the bathroom, have a meal etc, it is helpful if the posturing can be continued at home after your discharge for approximately 10 days.