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Retinal Detachment Surgery

Retinal Detachment Surgery

What Is Retinal Detachment?

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. Retinal detachments often develop in eyes with retinas weakened by a hole or tear. This allows fluid to seep underneath, weakening the attachment so that the retina becomes detached – rather like wallpaper peeling off a damp wall. When detached, the retina cannot compose a clear picture from the incoming rays and vision becomes blurred and dim.

If not promptly treated, retinal detachment can cause permanent vision loss.

Symptoms:

The most common symptom is a shadow spreading across the vision of one eye. You may also experience bright flashes of light and/or showers of dark spots called floaters. These symptoms are never painful.

Many people experience flashes or floaters and these are not necessarily a cause for alarm. However, if they are severe and seem to be getting worse and you are losing vision, then you should seek medical advice. Prompt treatment can often minimise the damage to your eye.

Screening And Diagnosis:

An ophthalmologist can look carefully at your eye with special instruments to determine what’s causing your visual symptoms. It’s possible to tell if you have a retinal hole, tear or detachment by looking at your retina with an ophthalmoscope — an instrument with a bright light and powerful lens that allows your doctor to view the inside of your eyes in great detail and in three dimensions.

If blood in your vitreous cavity prevents a clear view of the retina, your ophthalmologist might also use sound waves (ultrasonography) to assess your retina. Ultrasonography is a painless test that sends sound waves through your eye to bounce off the retina. The returning sound waves create an image on a monitor that allows your doctor to determine the condition of the retina and other structures inside your eye. This test usually provides the information your doctor needs to determine whether your retina is detached.

Different Types:

There are three different types of retinal detachment :

Rhegmatogenous [reg-ma-TAH-jenous] — A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

  • Tractional — In this type of detachment, scar tissue on the retina’s surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.
  • Exudative — Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

Who is at risk of retinal detachment?

Retinal detachment is more frequent in middle aged, short sighted people. However, it is quite uncommon and only about one person in ten thousand is affected. It is rare in young adults. It affects men more than women.

A retinal detachment is also more likely to occur in people who :

  • Are extremely nearsighted.
  • Have had a retinal detachment in the other eye.
  • Have a family history of retinal detachment.
  • Have had cataract surgery.
  • Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration.
  • Have had an eye injury.

Treatment:

Treatment of small holes or tears

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor’s office. During laser surgery tiny burns are made around the hole to “weld” the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.
Treatment of retinal detachments

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina.

If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape.

Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to “weld” the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost.

Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

Pneumatic Retinopexy

This surgical technique is generally used for a relatively uncomplicated detachment when the tear is located in the upper half of the retina. It’s usually done on an outpatient basis under local anesthesia. Often your surgeon initially will treat the retinal tear with cryopexy. Then, to soften the eye, he or she may withdraw a small amount of fluid from the space between the domed clear area at the front of your eye (cornea) and the colored part of your eye (iris). Next, your surgeon injects a bubble of expandable gas into the vitreous cavity. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of your eye.

How much vision can I expect after a successful operation?

A reattached retina doesn’t guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery, and if it was, for how long a period. Your sight isn’t likely to return to normal if the macula was detached.

It also depends on how much the retina has detached and for how long.

The shadow caused by the detachment will usually disappear when the retina has been put back in place. If your ability to see fine detail has been damaged before the operation, this may not fully recover afterwards.

Often retinal operations involve the use of a gas bubble which is inserted into the eye. This gas bubble helps the retina to heal correctly inside the eye. If a gas bubble is used then sight may be very poor for several weeks until the bubble is absorbed.

What happens after the operation?

Some people will be encouraged to get up and carry on as usual on the day after the operation, although most people will be asked to keep their head in a particular position to help the healing process. Your eye specialist will prescribe eye drops and you will need to use these for a few weeks.

You can resume normal activities as soon as you feel able.

What happens if the detached retina is not put back in place?

Most people will lose all useful vision if no operation is carried out, or if the treatment is unsuccessful.

However, if the first operation does not succeed, it is usually possible to have one or more operations to re-attach the retina. At each stage your surgeon will discuss with you the prognosis and the need to have more treatment

Can retinal detachment be prevented?

If your family has a history of retinal detachment, or your doctor finds a weakness in your retina, then preventive laser or freezing treatment may be needed. However, in most cases it is not possible to take preventive action.

Retinal detachment does not happen as a result of straining your eyes, bending or heavy lifting.

What about my other eye?

If you have had a retinal detachment in one eye, then there is a small risk of developing one in the other eye. This eye shuold be examined in detail by your doctor and any tears or holes in the retina should be treated.

What if my sight is not as good as before?

You can be helped to see many of the things you used to by making use of remaining sight. Low vision services can help. They can help you find the best magnifiers for you, and can give advice and training about the many, often simple, ways that you can make the most of your sight. Ask your eye specialist, optometrist (ophthalmic optician), GP, social worker or local voluntary organisation about low vision services near you. RNIB can also advise on the help that is available.

What are the skills someone develop to cope with the decreased visual acuity?

Unless you undergo prompt surgery, retinal detachment will cause you to lose vision in the portion of your field of vision that corresponds to the detached part of the retina. Losing part of your vision can greatly change your lifestyle — affecting your ability to drive, read and do many other things you’re accustomed to doing. Yet there are ways to cope with impaired vision :

  • Get special glasses – Optimize the vision you have with glasses that are specifically prescribed for the effects of retinal detachment and keep an extra pair in the car.
  • Brighten your home – Have proper light in your home for reading and other activities.
  • Make your home safer – Eliminate throw rugs and other tripping hazards within your home.
  • Enlist the help of others – Tell friends and family members about your vision problems so that they can help you perform certain tasks and help you recognize people.
  • Talk to others with impaired vision – Take advantage of online networks, support groups and resources for people with impaired vision.

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