Retinal Detachment

Retinal Detachment (Decollement)

WHAT IS RETINAL DETACHMENT?

Retinal detachment is the separation of the retinal nerve layer from the retinal pigment epithelium (RPE), the supporting tissue underneath. The retina is a thin nerve tissue at the back of the eye that detects light and transmits it to the brain. Retinal detachment is an emergency and can lead to blindness if not treated quickly.

Retinal detachment separates the retinal cells from the layer of blood vessels that supply oxygen and nutrients to the eye, causing permanent visual impairment. In this case, permanent dysfunction occurs in the retina whose nutrition is impaired.

WHAT ARE THE SYMPTOMS OF RETINAL DETACHMENT?

Retinal detachment does not cause pain. People with the following symptoms should be considered to have retinal detachment.

• Spotted floaters in the field of vision
• Light flash (photopsy)
• Blurred and distorted vision
• Diminishing peripheral vision
• Curtain-like shadows in the field of view

WHAT ARE THE RISK FACTORS FOR RETINAL DETACHMENT?

• Age: Retinal detachment is more common over the age of 50.
• Retinal detachment in one eye increases the risk of retinal detachment in the other eye.
• Family history of retinal detachment.
• Myopia: The risk of retinal detachment increases especially in high myopia. In particular, this risk increases significantly in people with myopia of -6.00 diopters or more. This is due to the greater tension in the retina due to the larger size of myopic eyes.
• The risk increases after cataract surgery.
• Previous eye injuries increase the risk of detachment.    
• Previous eye disease, including retinoscisis, uveitis or thinning of the peripheral retina (lattice degeneration).

WHEN TO SEE A DOCTOR?

If you are experiencing signs or symptoms of retinal detachment, you should seek medical attention immediately. Retinal detachment is a medical emergency in which you can permanently lose your vision.

WHAT ARE THE CAUSES OF RETINAL DETACHMENT?

There are three different types of retinal detachment:

Rhegmatogenous Retinal Detachment: This is the most common type of retinal detachment. Fluid from the tear escapes under the retina and causes retinal detachment. In the areas where the retina detaches, blood flow is disrupted and the retina is permanently damaged, resulting in permanent vision loss.

The most common cause of retinal detachment is aging. As you age, the gelatinous structure that fills the inside of your eye, known as vitreous, can change in consistency, shrink or become more liquid. The vitreous can separate from the retinal surface without any complications. This is called posterior vitreous detachment (PVD). A complication of this detachment is rupture.

As the vitreous separates from the retina, it can pull the retina strongly, creating a retinal tear. If left untreated, the liquid vitreous will pass through the tear into the space behind the retina, causing the retina to detach.

Tractional Retinal Detachment: This is the pulling and detachment of the retina due to fibrosis (scar tissue) on the retinal surface. Tractional detachment is typically seen in people with poorly controlled diabetes or other conditions.

Exudative Retinal Detachment: In this type of detachment, fluid accumulates under the retina, but there is no hole or tear in the retina. Exudative detachment (central serous retinopathy) can be caused by age-related macular degeneration, eye injury, tumors or inflammatory disorders.

HOW IS RETINAL DETACHMENT DIAGNOSED?

Retinal detachment is diagnosed with a comprehensive eye examination and some specialized tests. Here are the main methods used in the diagnostic process:

Fundus Examination:

        Ophthalmoscopy: The ophthalmologist uses an ophthalmoscope to examine the back of the eye (retina) through dilated pupils. In this way, it is possible to see retinal detachment, retinal tears or holes.

        Biomicroscopy (Slit Lamp Examination): This microscope is used to examine the anterior and posterior segments of the eye and examines the retina in detail.

        Ultrasonography:

        Ultrasound is used to visualize the back of the eye, especially when the retina is not fully visible. This method is very effective in detecting retinal detachment.

 Optical Coherence Tomography (OCT):

        This advanced technology, which provides a detailed cross-sectional image of the retinal layers, is used to detect retinal detachment and other retinal disorders.

  Fluorescein Angiography:

        To visualize the vessels of the eye, a dye is injected into the blood vessels and photographs are taken of the retina. This method can be used to detect fluid accumulation under the retina or retinal tears.

The patient’s complaints and medical history are also taken into account during the diagnostic process. Symptoms of retinal detachment may include flashes of light, floaters, shadows or dark areas in the field of vision. If these symptoms are present, it is important to seek urgent medical attention.

HOW IS RETINAL DETACHMENT TREATED?

If the retinal tear or hole has not yet started to detach, your eye surgeon may recommend one of the following procedures to prevent retinal detachment and preserve vision.

Laser surgery (photocoagulation): The surgeon directs the laser beam into the eye through the pupil. The laser creates burns around the retinal tear, often riveting (fusing) the retina to the underlying tissue.

Freezing (cryopexy): After giving you local anesthesia to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing helps to stabilize the retina to the eye wall.

Both of these procedures are done on an outpatient basis. You will probably be advised to avoid activities that may strain your eyes, such as running, for a few weeks after the procedure.

Pneumatic retinopexy

If your retina has detached, you will need surgery to relieve it, preferably within a few days of diagnosis. The type of surgery your surgeon will recommend will depend on several factors, including the severity of the detachment.

Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy, the surgeon injects a bubble of air or gas into the central part of the eye (vitreous cavity). If positioned properly, the bubble pushes the area of the retina with the hole or holes against the eye wall, stopping the flow of fluid into the space behind the retina. Your doctor also uses cryopexy during the procedure to repair retinal tears.

The fluid that accumulates under the retina is absorbed on its own and the retina may stick to the eye wall. You may need to hold your head in a certain position for a few days to keep the air or gas bubble in the correct position. The bubble will eventually reabsorb on its own.

Indenting the surface of your eye. This procedure, called scleral buckling, involves the surgeon sewing a piece of silicone material into the white part of your eye (sclera) over the affected area. This procedure indents the eye wall and relieves some of the force caused by the pull of the vitreous on the retina.

If you have multiple tears, holes or a large tear, your surgeon can create a scleral buckle that will wrap around your entire eye like a belt. The buckle is placed so that it does not obstruct your vision and usually stays in place permanently.

Draining and replacing the fluid in the eye. In this procedure, called a vitrectomy, the surgeon removes the vitreous along with any tissue that is pulling on the retina. Air, gas or silicone oil is then injected into the vitreous cavity to help flatten the retina.

Eventually the air, gas or liquid will be absorbed and the vitreous cavity will refill with body fluid. If silicone oil was used, it can be surgically removed months later.

Vitrectomy may be combined with a scleral buckling procedure.

It may take several months for your vision to recover after surgery. You may need a second operation for successful treatment. Some people never regain all the sight they have lost. However, it is important to remember that it is better to have less vision than no vision at all.

The content of our website is for informational purposes. It does not constitute a diagnosis or treatment recommendation. An ophthalmologist should be consulted for definitive diagnosis and treatment.