By
Jonathan Yoken, MD
RETINAL
TEARS AND DETACHMENT
What is
a retinal detachment?
The retina
is normally attached to the inside wall of your eye, like wallpaper.
A retinal detachment occurs when the retina is separated from
the inside wall of the eye. The retina will not function when
this occurs. If the center of the retina, the macula, is involved,
the vision is often extremely blurred. If the macula is not involved,
there may be some loss of peripheral vision corresponding the
part of the retina that is detached.
A retinal
detachment is a very serious problem that will almost always lead
to blindness if not treated.
What causes
a retinal detachment?
The center
of the eye is filled with a clear gel called the vitreous. As
we get older, the vitreous begins to degenerate into a liquid
and this causes it to pull away from the surface of the retina.
This process, called a posterior vitreous detachment, or PVD,
usually occurs without damaging the retina. But in some cases,
the vitreous may pull hard enough to tear the retina in one or
more places. As time passes, fluid from the center of the eye
will pass through the tear and begin accumulating beneath the
retina, causing a retinal detachment. There are some conditions
that increase the likelihood of developing a retinal detachment.
These include:
Are there
warning signs of a retinal detachment?
Early symptoms
of a retinal detachment include flashing lights, new floaters,
or a loss of part of the peripheral vision in one eye. These symptoms
do not always indicate a detachment is present, but they should
be promptly evaluated by your eye doctor.
How are
retinal tears and detachments treated?
If your eye
doctor discovers a retinal tear, it can usually be treated in
the office with laser surgery or cryotherapy. Both
procedures are done to seal off the retina around the tear and
prevent the development of a retinal detachment. These procedures
are usually performed with little or no discomfort in the office
and are highly successful. There are sometimes circumstances where
a tear or retinal hole may not require treatment, or cases where
despite treatment, new tears or a detachment occurs.
Retinal detachments
require surgery to correct. There are several different techniques,
and in some cases, a procedure can be done in the office to repair
the detachment.
Pneumatic
retinopexy is a procedure that can be performed in the office
to repair a retinal detachment. Depending on the characteristics
of the detachment, this sometimes can be an ideal treatment that
avoids the need for a trip to the operating room. This procedure
is accomplished by injecting a gas bubble into the center of the
eye, where the vitreous gel is located. The bubble then floats
up against the tear in the retina, and pushes the retina back
up against the wall of the eye. The tear still needs to be sealed
with cryotherapy or laser. The gas bubble will dissolve on its
own.
Scleral
buckle surgery is performed in the operating room and involves
placing a flexible band around the outside of the eye to counteract
the pulling force of the vitreous gel on the detached retina.
This also involves cryotherapy to seal the retinal tear. The band
usually remains in place indefinitely.
Vitrectomy
surgery also requires a trip to the operating room and involves
the removal of the vitreous gel from the inside of the eye. Laser
is used to reattach the retina, and a self-dissolving gas bubble
is placed inside the eye to hold the retina in place while it
heals. The vitreous does not regenerate, but the eye will function
normally without it.
Sometimes
these procedures are performed simultaneously or sequentially
depending on the particular characteristics of the detachment.
Are there
risks to surgery?
All surgery
has risks, even those performed in the office. However, most retinal
tears and detachments that are not treated will result in permanent
blindness. Some risks of surgery include, but are not limited
to infection, bleeding, cataract, elevated eye pressure, and reoccurrence
of the retinal detachment. Fortunately, most retinal tear and
detachment repair is successful, even if a second operation is
required.
