Retinal detachment is an emergency and can lead to loss of vision if not treated in a timely manner.
At Retina San Diego, all retinal detachments are seen as emergencies 24/7.
WHAT IS A RETINAL DETACHMENT?
The retina is the tissue that contains the photoreceptors which are the cells that respond to light and transforms that light energy into chemical and electrical energy which travels through the nerve of the eye to the brain and allows us to see. A retinal detachment happens when there is fluid underneath the retina which prevents the proper functioning of the cells within the retina and can lead to blindness if not treated.
What are the different types of retinal detachments?
- Rhegmatogenous Retinal Detachment: from the Greek word "rhegma" for "tear". A tear in the retina usually results from an area of thinning within the retina, or from pulling forces from the vitreous gel inside the eye, or from trauma. The gel that fills the back of the eye (called "vitreous gel") changes with time as part of it melts (liquefies) causing it to separate from retina. This separation is a normal occurence that happens in most people as we age, however in some people, the vitreous gel is very adherent to the retina and may cause a tear in areas of the retina that are thin as it is separating. A tear within the retina is an opening through which the fluid within the eye can go through and cause an elevation or detachment of the retina, which can lead to blindness if not treated. This type of detachment is also more common in people who are nearsighted (myopic). A rhegmatogenous retinal detachment always requires treatment.
- Tractional Retinal Detachment: scarring that pulls on the retina and causes elevation of the retina, most commonly from diabetes, but can also be seen in premature infants, or people with sickle cell trait, or other less common diseases. When it is secondary to diabetes, it can be observed as many cases can be stable and not affect central vision. In premature infants, retinal detachments should always be treated.
- Exudative Retinal Detachment: fluid is excreted under the retina usually from a tumor or an inflammatory process. Treatment depends on the etiology.
WHAT ARE THE SIGNS OF A RETINAL DETACHMENT?
The most common signs of a retinal detachment are the appearances of new floaters or cobwebs, flashes of light or seeing a curtain or a shade covering part of your vision. Your retina specialist should be contacted as an emergency at the first appearance of these symptoms as the best time to treat a retinal defect is when there is a tear that has not lead to a detachment yet.
WHAT ARE THE TREATMENTS FOR A RETINAL DETACHMENT?
There are many different options in the armamentarium of the retina specialist in the treatment of a retinal detachment depending in part on the location of the detachment, the extent of the detachment and the configuration or size of the retinal tear.
Pneumatic Retinopexy: When a retinal tear that is the culprit of a retinal detachment is found in the superior half of the retina, an in-office procedure can be done in order to treat the detachment. A gas is injected into the eye in order to tamponade the tear and prevent more fluid from going under the retina, thus allowing the body to resorb the remaining fluid from underneath the retina. Laser can then be used to create a scar that will seal the area surrounding the tear in order to prevent fluid from going through the tear.
Vitrectomy Surgery: Vitrectomy is the most modern and most common type of surgery done for a retinal detachment. The vitreous gel that is the culprit of the retinal tear in most detachments is removed and the fluid underneath the retina is drained to flatten the retina with the use of gas. Laser is then applied to surround the retinal defects and to strengthen the adhesion of the peripheral retina. Gas is injected into the eye the act as a tamponade while the Laser scars form their adhesions and the retina heals in proper position. Gas stays inside the eye from 6 to 8 weeks in the majority of cases. Certain detachments require the use of an oil (silicone oil) as a tamponade, however silicone oil requires a second surgery to remove the oil.
Scleral Buckle: Prior to the advent of Vitrectomy surgery, scleral buckle was used as the main treatment for retinal detachments. Scleral buckle is still used for certain types of detachments and is beneficial in younger patients as it does not affect the lens of the eye.