Retinal Detachment: causes symptoms and treatments

Signs and symptoms of retinal detachment

If you are experiencing any of the below signs or symptoms of retinal detachment, it is critically important to get  immediate medical attention:

• The sudden appearance of many floaters — multiple tiny specks that seem to drift through your field of vision
• Flashes of light in the affected eye (a phenomenon known as photopsia)
• Blurred vision
• A sensation of a curtain closing or a fixed shadow which appears in your peripheral field of vision

How to diagnose retinal detachment

A careful eye examination through a dilated pupil is required to diagnose retinal tears or detachment.

Retinal detachment risk factors

The following risk factors increase your chance of having a retinal detachment:

• Retinal tear—because vitreous gel tends to pull away from the retina over time, it can tug on the retina and cause a tear that leads to detachment
• Prior retinal detachment in one eye (gives you a 10% chance of developing a detachment in your other eye)
• Family history of retinal detachment
• A high degree of nearsightedness (myopia)
• Prior eye surgery, such as cataract removal
• Prior severe eye injury
• Thinning of the peripheral retina (called lattice degeneration)

Retinal detachment treatment

Almost all patients with retinal detachment will need surgery to place the retina back in its proper position. The good news is that 90 percent of retinal detachment surgeries are successful with a single operation. That said, a second operation is sometimes needed.

While a laser office procedure can be used to treat a retinal tear in order to prevent a retinal detachment, it cannot be used to repair an already detached retina that is no longer in contact with the eyewall.

This is because, with a retinal tear, the eyewall underneath the retina absorbs the energy from the laser to create a scar that fuses the edges of the tear to the eyewall.

Because a detached retina has no contact with the eyewall, there is no surface available to receive the laser energy. This is why when the retina has already detached. Other surgical methods are required to repair it.

Retinal detachment surgery

Surgery is usually performed within a day or two of the diagnosis of a detachment, particularly if the macula and central vision are not yet affected.

There are three surgical options available for repairing detached retinas. The necessary procedure is determined by a retinal specialist based on the specific condition of each individual detachment.

Scleral Buckling

Scleral Buckling is a surgical procedure that sews a silicone band (buckle) to the outer white part of your eye (called the sclera) over the area of the retinal tear. The buckle is placed in a way that doesn't block your vision, and it usually remains in place permanently.

This causes the eyewall to indent, counteracting the force pulling the retina out of place. The fluid under the detached retina is drained, which allows the retina to settle back into its normal position against the back wall of the eye. Once the retina is flattened against the eyewall, a laser is used to weld the retinal tears' edges, sealing the leak.

Pneumatic Retinopexy

Pneumatic Retinopexy is an office procedure that may be appropriate in the case of a small detachment caused by a single tear that’s located at the top of the retina.

This treatment involves a small gas bubble being injected inside the eye in order to plug the retinal tear responsible for the detachment. This allows the fluid collected behind the retina to be gradually reabsorbed so that the retina can adhere to the eyewall again.

Once the retina re-attaches, usually within several days, the causative retinal hole is sealed with laser photocoagulation or cryotherapy. Recovery after this treatment involves special head positioning in order to keep the bubble in the proper place for healing. The bubble will reabsorb on its own over a few days.

Vitrectomy

In this procedure, three small incisions are made in the white part of the eye, and tiny instruments are used under microscopic guidance to remove the vitreous (jelly-like fluid) that fills the eye.

Because the eye does not need vitreous to function, the fluid collected under the retina is drained, and a special gas (in some cases silicone oil) is then placed inside the eye to help push the detached retina against the eyewall while it heals. Laser photocoagulation is also used to seal the retinal breaks.

The gas is gradually absorbed by the body over several weeks, and the inside of the eye eventually re-fills with vitreous fluid, which the eye is continually producing. If silicone oil was used, a second procedure would be needed to remove it after several weeks to months.

 Learn more about vitrectomies here.

What to expect after retinal detachment surgery

After the retinal detachment surgery, the eye is patched for 24 hours. If a gas bubble is used to repair the retina, the patient is placed face down immediately after the surgery and must maintain this position so that the bubble can float up to press the detached tissue against the eyewall.

The duration of face-down positioning is determined by the doctor, it can range from 1 to 5 days, and avoid flying and higher altitudes for one to three months following surgery (depending on the type of gas used) to avoid irreversible vision loss.

Patients can usually resume normal everyday activities within a few days of surgery. While the retina heals, they will be asked to:

• Avoid impact activities, swimming pool use, contact sports, or heavy lifting.
• Use eye drops (topical steroids and antibiotics) for several weeks following surgery.

• Return to be examined by their surgeon on the day after surgery,  one week after surgery, and one month post-op in order to closely monitor retinal healing.

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Retinal detachment surgery risks

Complications may occur, but they are infrequent and less than one in 2000 cases. Risks and complications of all retinal surgeries include:

• Bleeding
• Infection
• Not fully recovering your vision
• Retinal detachment recurrence, which can require more surgery
• An increase in eye pressure (glaucoma)
• Damage to nearby eye structures
• Increased risk of cataracts due to post-op changes in the eyes' lens
  
  

Vision improvement after retinal reattachment surgery

Retinal detachment surgery has two goals:

• Reattach the retina, thus restoring the eye anatomy
• Recover as much lost vision as possible

Nine out of ten surgeries performed to repair a detached retina succeed in reattaching the retina. It is important to understand, however, that vision recovery following this surgery is slow and can take from weeks to months.

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The precise outcome of each surgery is largely dependent on the unique location of each patient’s detachment and the extent of the detachment since no two detachments are alike.

The most important factor in predicting your final eyesight is the vision that you have immediately before surgery. If your vision is initially good (namely, the central vision area was not detached), postoperative vision tends to return close to the baseline. However, if your vision is very reduced pre-operatively (due to detachment in the central vision area), your final vision may be decreased even if the retina is successfully reattached.

It's important to note that your final vision may also be decreased by the later development of a cataract, which often occurs following vitrectomy surgery. But cataract surgery is typically highly successful in restoring vision in such cases, so this can be corrected.

Choose Assil Gaur Eye Institute for your retinal care

The AGEI team includes highly-skilled retina specialist Dr. Svetlana Pilyugina or “Dr. P”, as she is known to her patients. Dr. Pilyugina is an ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina.

Dr. P has been performing retinal surgery for over a decade and has considerable experience in the treatment of a broad range of retinal conditions.