Retinal detachment means that the light-sensitive tissue in the back of the eye has detached from the underlying supporting tissue, the so-called choroid.
The retina is the photosensitive layer of tissue that lines the inside of the eye and sends the visual signals to the brain via the optic nerve.
What happens during retinal detachment?
- The inside of the eye is largely filled by the vitreous body, a gelatinous, transparent mass that lies between the retina and the lens.
- The vitreous body is firmly attached to the retina, a vitreous detachment can thus pull off the retina at its weakest points and cause cracks.
- The fluids inside the eye can penetrate through these cracks and lead to retinal detachment.
Rarely, retinal detachment is bilateral, the cause is mainly systemic (affecting the entire organism) and congenital (congenital) diseases.Forms of retinal detachment
1. Tear-related (rhegmatogenous) retinal detachment occurs as a result of a rupture (usually a tear or hole) in the retina, which allows fluid to penetrate into the area under the retina.
The lesions in the retina do not necessarily cause symptoms, in fact 78% of cases are asymptomatic.
It is therefore important to perform routine examinations of the eye, especially if the patient is nearsighted or engaged in contact sports that could lead to trauma to the eye.
In addition, in a short-sighted person, the risk of peripheral retinal degeneration is greater, which can increase the risk of retinal detachment.
Rhegmatogenous retinal detachment is the most common form.
Patients operated on the eye are at risk, especially if they have had cataracts removed.
2. Exudative retinal detachment can occur due to inflammation, injury or vascular disease that causes fluid retention under the retina without an existing retinal hole or tear.
3. Pull-related retinal detachment can occur when fibrous or fibrovascular tissue forms on the retina as a result of injury or inflammatory disease or due to neovascularization, as in diabetogenic retinopathy.
The scar tissue pulls the retina away from the underlying pigment layer on which it is normally attached, thus causing pull-related retinal detachment.
The retinal detachment often has the shape of a “horseshoe”.
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Causes of retinal detachment and risk factors
Retinal detachment can occur at any age, but it is most common in people over 40 years of age.
Men are affected more often than women.
Retinal detachment is more likely in people who:
- have moderate to increased myopia (more than 3 diopters);
- had already had a retinal detachment in the other eye;
- have a familial accumulation of retinal separations;
- had cataract surgery;
- suffer from other eye diseases, such as retinal cleavage (retinoschisis), inflammation of the middle skin of the eye (uveitis) or degenerative myopia;
- had an eye injury;
- have diabetes;
- suffer from genetic diseases, such as Marfan syndrome and Ehlers-Danlos syndrome (EDS).
In children, the most common causes of detachment of the retina are:
- congenital diseases, such as Marfan and Wagner syndromes;
- Traumas;
- a previously performed eye operation.
According to some studies, high temperatures can increase the risk of retinal detachment:
the heat leads to dehydration of the tissues and can cause changes in the vitreous.
As a result, tensile forces arise that can lead to detachment of the retina.
Symptoms of retinal detachment
There are signs and symptoms that may indicate possible detachment of the retina, including:
- swimming bodies in the eye (mouches volantes or flying mosquitoes),
- flashes of light or flashes,
- loss of vision,
- Shadows and blind spots in the field of vision.
Patients with retinal detachment do not feel pain.
Diagnosis of retinal detachment
The ophthalmologist can assess retinal detachment through a series of examinations of the retina and pupil, such as:
- examination of the base of the eye with an ophthalmoscope,
- examination with slit lamp,
- Ultrasound of the eye.
Therapy of retinal detachment
If the patient perceives flashes of light in the field of vision, he should visit the emergency room, as it could be a detachment of the retina.
If the detachment occurs at the level of the macula (middle part of the retina), the ophthalmologist recommends immediate surgical treatment to prevent irreparable loss of vision.
Rupture in the retina
If the lesion has not progressed to retinal detachment, the eye surgeon may recommend outpatient treatment to prevent retinal detachment and preserve vision almost completely.
- Laser surgery (photocoagulation).
The surgeon directs the laser beam at the retinaltear. Before that, a contact lens is positioned on the patient’s cornea so that the ophthalmologist can see the lesion.
After that, the laser creates burns (spot) around the area of partial detachment to create scars that “weld” the retina to the tissue. - Cold treatment or cryopexia
The surgeon applies a cold probe to the outer layer of the eye just above the retinal tear and freezes the area around the lesion. The result is a scar that welds the retina to the walls of the eye.
The ophthalmologist prefers this laser treatment if there are cloudiness (e.g. cataract) that does not clearly show the lesion.
The doctor orders a restraint from intense activity for the following two weeks to allow the fibrous tissue produced by cold treatment to consolidate.
Intervention in case of complete retinal detachment
If the retina has completely detached, this is a serious problem. The doctor then performs surgery to repair them.
If treatment is not carried out within 2 weeks, the retina shrinks and the likelihood of successful intervention is significantly reduced.
The procedures can be performed together with photocoagulation and cryopexia.
Sometimes a second surgical intervention is required to solve the problem, even if in 80% of cases a single operation is sufficient.
The procedure is performed under local anesthesia and usually no inpatient admission is required.
- Pneumatic Retinopexy
In this procedure, the doctor injects an air or gas bubble into the vitreous.
The bladder is inserted in such a way that it presses against the retinal tear and the surrounding area, thus closing the tear.
The gas stops the flow of fluid to the area where the detachment occurred (between the retina and choroid).
The fluid that has accumulated in the area of the lesion absorbs independently, and the retina can again attach itself to the posterior wall of the eye (choroid).
In the end, the bladder is automatically absorbed. - Episcleral cerclage (surgical intervention ab externo)
In this operation, also called scleral dentation, the doctor sews a silicone pad to the outside of the sclera (white part of the eye).
In the case of several lesions or a large detachment, the surgeon can place a scleral cerclage that surrounds the whole eye like a belt, or cover areas with a band or silicone pad (seals).
The outer layer of the eye is pressed inwards to approximate the outer wall of the eye to the detached retina and vitreous; in this way, the pull exerted by the vitreous body on the retina is reduced.
As a rule, myopia worsens after such a procedure, but this can be corrected by glasses or contact lenses. - Vitrectomy (surgical intervention ab interno)
In this procedure, the surgeon removes the vitreous along with any other tissue that pulls on the retina.
After that, air, gas or liquid (silicone oil) is injected into the vitreous cavity to reattach the retina.
Eventually, air or gas is absorbed and the space of the vitreous becomes a liquid body again.
To remove the silicone oil, another operation is necessary after about 2-3 months.
Vitrectomy is often performed together with a scleral dent.
Convalescence after surgery due to retinal detachment
After the procedure, the doctor applies a bandage, which must be worn for a certain period of time, depending on the type of procedure.
In pneumatic retinopexy, depending on the location of the detachment, the patient must take a certain position of the head after the operation, either tilted sideways, bent forward or lying on the operated side.
This position is extremely important until the air bubble pumped into the eye has been reabsorbed.
The probability of surgical success in retinal detachment depends on:
- number of lesions,
- Extent.
In most cases, the retina can be recreated in a single operation, even if some people need different procedures.
Less than 10% of detachments are inoperable.
The inability to restore the retina leads to vision loss and even blindness.
After the procedure, the quality of vision depends on where the retina had detached and what the cause was:
- If the central visual area (macula) is not affected, vision can become very good again.
- If the macula is damaged, vision improves again, but may appear distorted and wavy.
Many people can get used to these distorted images over time. - If the macula has been severed for a long time (macula-off), a partial restoration of vision is possible, but it will be very impaired.
Results of the operation
As a rule, surgery can repair the retina again. The degree of restoration of fine and peripheral vision depends on:
- how large the detached retinal part was,
- whether the macula has been detached,
- whether there is another eye disease such as diabetogenic retinopathy,
- how promptly the operation was performed.
If a shadow appears in the peripheral field of vision, it may disappear after the operation, but a peripheral visual impairment may remain.
Unfortunately, even if the retina has been reattached, detailed central vision or peripheral vision cannot always be restored.
This can happen in any case, but the risk is higher without treatment.
What happens if the retinal detachment cannot be eliminated or a recurrence occurs?
Most people lose their vision completely if surgery is not performed or treatment fails.
However, if the first operation is unsuccessful, another attempt to reattach the retina can be made.
What happens if the eyesight does not become the same as before?
If vision is lost in one eye due to detachment, you can still see with the other eye.
Sometimes it takes a few months to get used to seeing with only one eye when the other interferes.
Over time, the brain learns to ignore the decreased vision in most situations.
Recovery time (prognosis) after surgery for retinal detachment
- The procedure usually does not require hospitalization.
- Restoration of vision occurs when the air bubble pumped into the interior of the eye has dissolved; this takes a few weeks.
- You may need to limit physical activity for as long as the surgeon determines, about 4 weeks.
- Patients with a gas bubble in the eye are not allowed to travel by air or stay at high altitudes until the gas bubble has dissolved.
This is usually the case in a few weeks. - The ophthalmologist recommends avoiding natural childbirth and breastfeeding at the breast, because these are too strenuous for the mother and can worsen the condition of the eyes.
