Retinal detachment affects approximately 1 in 10,000 people each year. If left untreated, most retinal detachments will lead to loss of vision. An understanding of some of the normal anatomy of the eye may be useful in understanding how retinal tears and detachment occur and the symptoms which they may cause. The retina is a thin tissue that lines much of the inside of the eye. The center portion of the retina is called the macula. The macula is responsible for fine central vision and for color vision. The more peripheral parts of the retina provide peripheral vision...
When we are young, the vitreous is normally a clear structure which does not affect our vision. As we age, however, changes may occur within the vitreous... While most posterior vitreous detachments do not lead to more serious problems, sometimes a retinal tear or detachment may arise as a result...
As the vitreous pulls away from the retina during a posterior vitreous detachment, the retina may at times tear. Retinal detachment occurs if fluid from within the vitreous passes through the tear and collects under the retina... Retinal tears, if detected early, can usually be treated in such a way as to avoid retinal detachment.
Retinal tears can be treated using either laser photocoagulation or cryotherapy. Laser photocoagulation is a procedure where a special light is directed to the retina and used to create burns... Both laser photocoagulation and cryotherapy are usually performed in the doctor’s office and are usually successful in preventing retinal detachment.
Some retinal detachments, if diagnosed when the detachment is small, may be treatable with only laser photocoagulation or cryotherapy. More often, however, more extensive surgery is usually needed. The surgical procedures include:
This involves injecting a gas bubble into the vitreous cavity, which temporarily seals the tear. The patient is positioned so the bubble covers the tear while the fluid reabsorbs and permanent sealing (via cryopexy or laser photocoagulation) is applied. This procedure is often done in-office.
A silicone band is sutured to the sclera to indent the wall of the eye, reducing traction on the retina. Cryotherapy is applied to seal the tear, and any subretinal fluid is removed or allowed to reabsorb. This is performed in an operating room under local anesthesia.
For complicated detachments, vitrectomy surgery may be necessary to remove the vitreous and relieve traction on the retina. The retina is flattened and sealed, and the eye is filled with gas or silicone oil. Vitrectomy is performed in the operating room and may be combined with scleral buckling.
The type of surgery depends on the tear's location and whether scar tissue is present. Most retinal detachments can be successfully repaired, although more than one procedure may be needed. Visual outcomes depend heavily on whether the macula was detached before surgery. Vision recovery can continue for many months after a successful operation.
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