What is a Retinal Detachment?
In order to function properly, the retina needs to be flat against
the back of the eye. When a retinal detachment occurs, the
retina is unable to stay in its normal position. The retina does
not work when it is detached. If retinal detachment is not treated
quickly, it may lead to permanent blindness.
What are symptoms of Retinal Detachment?
Some of the early symptoms that may indicate a retinal
detachment are:
- Flashing lights
- New Floaters
- Blurry vision
- New area of shadow or curtain in the periphery of the
vision
- Gray shadow in your vision
Presence of any or all of these symptoms does not always
indicate a retinal detachment. These symptoms may also be
seen in association with certain other conditions. Only a trained
ophthalmologist can tell whether a retinal detachment is present
or not. Thus you should see your ophthalmologist as soon as
possible.
What causes a Retinal Detachment?
As we get older, the vitreous liquefies and can separate from the
back of the eye in a condition called Posterior Vitreous
Detachment or PVD. This separation usually happens cleanly
without any problems. However if the vitreous is densely
adherent at any point, as it separates, it can cause the formation
of a retinal tear. Then the liquid vitreous can travel through the
tear to area behind the retina and thus peels the retina off the
back of the eye, much like wallpaper peeling off the wall.
Certain conditions can predispose people to developing retinal
detachments:
- Nearsightedness
- History of cataract surgery
- Trauma
- History of retinal detachment in other eye
- Family history of retinal detachment
- Certain weak areas in the retina
- Presence of certain systemic conditions like Marfan’s
Syndrome
How is retinal detachment diagnosed?
In order to definitely diagnose a retinal detachment, you need to
undergo a dilated exam by your ophthalmologist
How is retinal detachment treated?
Depending upon the location and extent of retinal detachment,
your doctor may choose one of several options available to treat
the retinal detachment.
- Scleral Buckle: This surgery places a silicone band around the eye to
bring the detached retina and the eye wall closer together to relieve the
traction of vitreous on the tear. This reduces the amount of fluid getting
through the hole. In addition, the surgeon may use a freezing probe or laser to
help close the tear. If the band goes around the eye completely, it is called an
encircling band. Sometimes only a small area may need a band. This
procedure is usually done under local anesthesia in the operating room.
However general anesthesia is also sometimes used This band stays around
the eye permanently.
- Pneumatic Retinopexy: If the location of the tear and accompanying
detachment is located in the upper part of the eye, then the doctor might elect
to inject some gas into the eye in the office. Then the patient is asked to
position the head in certain way to aid in drainage of fluid underneath the
retina. A few days after this, the doctor will place some laser around the tear
to help keep it from causing the detachment again.
-Vitrectomy: Occasionally, a retinal detachment is so complicated and
severe that it cannot be treated with either standard scleral buckling surgery or
pneumatic retinopexy. In such cases, vitreous surgery to reattach the retina
may be necessary. Vitreous surgery is performed in an operating room usually
under local anesthesia. The vitreous is removed and, therefore, this procedure
is called vitrectomy. The surgeon uses a fiber optic light to illuminate the inside
of the eye and other instruments inside the eye, such as forceps, and scissors,
to do the surgery. The vitreous is replaced during the operation with either
clear fluid that is compatible with the eye, or with gas that completely fills the
eye. Over time, the fluid (or gas) is absorbed by the eye and replaced by the
eye's own fluid; the eye does not replace the vitreous itself. The lack of
vitreous does not affect the functioning of the eye.
Vitrectomy is required for retinal reattachment in a variety of conditions. For
example, scar tissue may grow on the vitreous or the surface of the retina and
pull on the retina and detach it. Occasionally, something in the vitreous, such
as blood, prevents the passage of light through the eye to the retina. The most
common conditions requiring vitrectomy are vitreous hemorrhage with retinal
detachment, proliferative vitreoretinopathy, giant retinal tears, diabetic
retinopathy with vitreous hemorrhage and/o traction retinal detachment,
epiretinal membrane(macular pucker), intraocular infection:endophthalmitis,
trauma, intraocular foreign body, and macular hole. Today vitrectomy is often
used to repair retinal detachment in eyes that have already cataract surgery.
In a vitrectomy, instruments are passed through the sclera into the vitreous
cavity. A variety of instruments can be used to remove the vitreous gel and
any scar tissue that may be growing on the surface of the retina. A laser probe
can be inserted into the eye so that laser treatment can be done during surgery.
Recent advancements in technology have led to smaller instrumentation for
vitrectomy surgery. Standard size for vitrectomy was 20 gauge until recently
when much smaller 25 gauge instrumentation became available. No suturing is
required in most cases. Healing is quicker, pain is less, and the overall
experience of vitrectomy surgery is much more comfortable for the patient.
Vitrectomy can be combined with the placement of a scleral buckle. Usually,
air, gas, or silicone oil is place in the vitreous cavity. Theses materials hold the
retina in place against the back wall of the eye while the laser scars are
forming. After this surgery, it may be important for the patient to maintain a
certain position of the head, which is often a face-down(prone) position.
Eventually, the gas is absorbed and replaced by fluid produced by the eye. If
silicone oil has been used, it frequently must be removed at a later time with
another surgical procedure. Vitreous surgery usually lasts one to two hours
but, with very severe and difficult problems, may take longer. Following
surgery, the patient may experience some discomfort and a scratchy sensation
in the eye, but significant pain is unusual. If it occurs, the surgeon should be
told promptly.
In order to function properly, the retina needs to be flat against
the back of the eye. When a retinal detachment occurs, the
retina is unable to stay in its normal position. The retina does
not work when it is detached. If retinal detachment is not treated
quickly, it may lead to permanent blindness.
What are symptoms of Retinal Detachment?
Some of the early symptoms that may indicate a retinal
detachment are:
- Flashing lights
- New Floaters
- Blurry vision
- New area of shadow or curtain in the periphery of the
vision
- Gray shadow in your vision
Presence of any or all of these symptoms does not always
indicate a retinal detachment. These symptoms may also be
seen in association with certain other conditions. Only a trained
ophthalmologist can tell whether a retinal detachment is present
or not. Thus you should see your ophthalmologist as soon as
possible.
What causes a Retinal Detachment?
As we get older, the vitreous liquefies and can separate from the
back of the eye in a condition called Posterior Vitreous
Detachment or PVD. This separation usually happens cleanly
without any problems. However if the vitreous is densely
adherent at any point, as it separates, it can cause the formation
of a retinal tear. Then the liquid vitreous can travel through the
tear to area behind the retina and thus peels the retina off the
back of the eye, much like wallpaper peeling off the wall.
Certain conditions can predispose people to developing retinal
detachments:
- Nearsightedness
- History of cataract surgery
- Trauma
- History of retinal detachment in other eye
- Family history of retinal detachment
- Certain weak areas in the retina
- Presence of certain systemic conditions like Marfan’s
Syndrome
How is retinal detachment diagnosed?
In order to definitely diagnose a retinal detachment, you need to
undergo a dilated exam by your ophthalmologist
How is retinal detachment treated?
Depending upon the location and extent of retinal detachment,
your doctor may choose one of several options available to treat
the retinal detachment.
- Scleral Buckle: This surgery places a silicone band around the eye to
bring the detached retina and the eye wall closer together to relieve the
traction of vitreous on the tear. This reduces the amount of fluid getting
through the hole. In addition, the surgeon may use a freezing probe or laser to
help close the tear. If the band goes around the eye completely, it is called an
encircling band. Sometimes only a small area may need a band. This
procedure is usually done under local anesthesia in the operating room.
However general anesthesia is also sometimes used This band stays around
the eye permanently.
- Pneumatic Retinopexy: If the location of the tear and accompanying
detachment is located in the upper part of the eye, then the doctor might elect
to inject some gas into the eye in the office. Then the patient is asked to
position the head in certain way to aid in drainage of fluid underneath the
retina. A few days after this, the doctor will place some laser around the tear
to help keep it from causing the detachment again.
-Vitrectomy: Occasionally, a retinal detachment is so complicated and
severe that it cannot be treated with either standard scleral buckling surgery or
pneumatic retinopexy. In such cases, vitreous surgery to reattach the retina
may be necessary. Vitreous surgery is performed in an operating room usually
under local anesthesia. The vitreous is removed and, therefore, this procedure
is called vitrectomy. The surgeon uses a fiber optic light to illuminate the inside
of the eye and other instruments inside the eye, such as forceps, and scissors,
to do the surgery. The vitreous is replaced during the operation with either
clear fluid that is compatible with the eye, or with gas that completely fills the
eye. Over time, the fluid (or gas) is absorbed by the eye and replaced by the
eye's own fluid; the eye does not replace the vitreous itself. The lack of
vitreous does not affect the functioning of the eye.
Vitrectomy is required for retinal reattachment in a variety of conditions. For
example, scar tissue may grow on the vitreous or the surface of the retina and
pull on the retina and detach it. Occasionally, something in the vitreous, such
as blood, prevents the passage of light through the eye to the retina. The most
common conditions requiring vitrectomy are vitreous hemorrhage with retinal
detachment, proliferative vitreoretinopathy, giant retinal tears, diabetic
retinopathy with vitreous hemorrhage and/o traction retinal detachment,
epiretinal membrane(macular pucker), intraocular infection:endophthalmitis,
trauma, intraocular foreign body, and macular hole. Today vitrectomy is often
used to repair retinal detachment in eyes that have already cataract surgery.
In a vitrectomy, instruments are passed through the sclera into the vitreous
cavity. A variety of instruments can be used to remove the vitreous gel and
any scar tissue that may be growing on the surface of the retina. A laser probe
can be inserted into the eye so that laser treatment can be done during surgery.
Recent advancements in technology have led to smaller instrumentation for
vitrectomy surgery. Standard size for vitrectomy was 20 gauge until recently
when much smaller 25 gauge instrumentation became available. No suturing is
required in most cases. Healing is quicker, pain is less, and the overall
experience of vitrectomy surgery is much more comfortable for the patient.
Vitrectomy can be combined with the placement of a scleral buckle. Usually,
air, gas, or silicone oil is place in the vitreous cavity. Theses materials hold the
retina in place against the back wall of the eye while the laser scars are
forming. After this surgery, it may be important for the patient to maintain a
certain position of the head, which is often a face-down(prone) position.
Eventually, the gas is absorbed and replaced by fluid produced by the eye. If
silicone oil has been used, it frequently must be removed at a later time with
another surgical procedure. Vitreous surgery usually lasts one to two hours
but, with very severe and difficult problems, may take longer. Following
surgery, the patient may experience some discomfort and a scratchy sensation
in the eye, but significant pain is unusual. If it occurs, the surgeon should be
told promptly.
| Retinal Detachment |
| Scleral Buckle |
| Pneumatic Retinopexy |
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| CAROLINA RETINA INSTITUTE,PC Diseases and Surgery of the Retina, Vitreous, and Macula |
| Amit Kumar, MD Board Certified Ophthalmologist Fellowship Trained Vitreoretinal Surgeon |
| 940 SE Cary Parkway, Suite 100 Cary, NC 27518 |
| Fax: (919) 859 4515 (919) 859 4511 email: carolinaretina@gmail.com |
| 1011 W. Williams St, Suite 103, Apex, NC 27502 |