What is it?
The retina is the delicate, inside lining of the eye. It acts like the film in a film camera; it captures the picture and sends the information to the brain. A retinal detachment occurs when the retina pulls away from the eye wall. It is a serious problem which requires urgent surgery. Without surgery, vision can be permanently affected.
What causes it?
The eye has a central cavity which contains a jelly-like substance called the vitreous. As one ages, the vitreous changes from a gel to a liquid. As a result, the vitreous can separate from the retina. This is a normal aging change and is called a Posterior Vitreous Detachment (PVD). For many people, this change can cause flashing lights and new floaters but no serious retinal changes. However, a PVD may create a retinal tear in some people. This retinal tear leads to a retinal detachment. The liquefied vitreous can track through the tear and under the retina. Then, just like pouring water behind wall paper, the retina can detach from the eye wall.
What are the symptoms?
Flashing lights and new floaters are often the only symptoms of a retinal tear. If you ever experience these changes, you should contact your retina specialist for a dilated retinal examination. If a retinal detachment develops, one notices a loss of side/peripheral vision. There is often a shadow or curtain-like defect which is always present. With time, the shadow or curtain can progress towards the center. If a retinal detachment is not treated, then total vision loss can occur.
Retinal detachments are infrequent in the general public, and tend to affect people over age 40. Some common risk factors are myopia (near-sightedness) and previous eye surgery. Other causes include a family history of retinal detachment, trauma to the eye, and certain genetic conditions.
What is the treatment?
Retinal detachments require surgical repair by a vitreoretinal surgeon. Both of our doctors are experienced in the various types of detachment surgery. Based on your eye and your detachment, they will recommend a surgery which has the highest chance of longterm success. Currently there are three surgeries which are employed to fix this retinal problem.
This procedure is the least invasive, but can only be used in certain situations. At the time of surgery, the eye is anesthetized and then the retinal tear is treated with cryo (an ultra-cold probe). Next a gas bubble is injected into the vitreous cavity. The patient is then given clear instructions regarding positioning for the next 24- 72 hours. With proper positioning, the gas bubble seals the tear and allows the detachment to heal. This technique can be very effective but requires close monitoring in the post-op period.
This procedure is often used for younger patients who have never had cataract surgery. A cryo probe is used to treat all of the retinal tears. Next a thin silicone band is placed around the outside of the eye wall (the sclera). The band encircles the sclera, and is tightened like a belt which indents the eye. This indentation brings the eye wall closer to the retina and counteracts the pulling of the vitreous gel. Once the buckle is in place, your surgeon may choose to inject an air or gas bubble into the eye. Post-op positioning is also important for this technique. The eye is usually sore for the first 2-3 days and pain medication may be required. The buckle is tucked behind the eyelids and once the eye heals, it is not visible. Your retina specialist will monitor the eye closely to ensure that the retina remains attached.
This type of surgery is usually employed for people who have already had cataract surgery. Three small incisions are made through the white wall of the eye. These incisions are so small that they self-seal (no stitches are needed). The vitreous gel is then removed with a highly specialized instrument that “cuts” and “sucks” at the same time. Once the gel is gone, the retina is re-attached and sealed in place with laser treatment. To keep the retina attached, either a gas bubble or oil bubble is injected. The gas bubble is absorbed by the eye in 4-8 weeks. During this time, the patient must avoid high altitude because the gas may expand. For example, one must not fly in an airplane or travel through the mountains. The oil bubble is not absorbed by the eye. A second procedure is required in 3-4 months to remove the oil.
What is the recovery?
They eye may be quite sore after a scleral buckle for the first week. There is usually less pain and discomfort with a pneumatic retinopexy or vitrectomy. If you have significant pain or nausea which isn’t controlled with regular pain medication then you should call our office. We will monitor the eye at regular intervals following the surgery. It is common for the vision to be very blurry after surgery. It is impossible to see through a gas bubble, so the vision only returns once the bubble gets smaller. A window of vision will start to appear above the bubble, and will slowly enlarge as the bubble gets absorbed. The vision is slightly better through an oil bubble, but will still be blurry. Drops are required after the surgery, your surgeon will give you instructions about the type and frequency.