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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 |
| Vitrectomy |