As described in the Anatomy section, the retina is much like the bladder in a basketball, in that it's normal position is against the outer wall of the eye. It receives its oxygen and nutrients via the choroid, and it needs to be adjacent to the choroid for the light to strike the retina normally and provide good vision to the brain.
Occasionally, and for many different reasons, the retina can become detached, the most common cause due to a posterior vitreous detachment (see Floaters, Flashes, and PVD). Other causes of retinal detachment include diabetic retinopathy, retinal tumors, retinal inflammations, infections, etc. As mentioned, when the retina is detached it is no longer against the outer wall of the eye, and therefore is not receiving the oxygen and nutrients from the choroid that it needs to perform correctly. In addition, it is not in the correct anatomical position to send messages to the brain and as a result the patient’s vision is profoundly decreased.
The signs and symptoms of retinal detachment include flashes and floaters, as mentioned in the Posterior Vitreous Detachment section, and a shadow, veil, or curtain coming over the vision (the area of actual detachment).
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Retinal Detachment The vitreous pulls on the retina, causing a retinal tear ("flap tear"), and with constant contraction fluid enters the subretinal space and peels the retina off causing a retinal detachment. |
Retinal detachments can be repaired using several different techniques including pneumatic retinopexy, scleral buckling, or vitrectomy surgery. In Pneumatic Retinopexy either cryopexy or laser therapy is applied around the area of the retinal holes either before or after a gas bubble is injected in the eye. The patient’s head is positioned so that the gas bubble floats against the holes, closing them, allowing the subretinal fluid to be resorbed and allowing the retina to reattach. In many instances cryotherapy is applied around the retinal holes prior to placement of the gas bubble. Some physicians, however, prefer to place the gas bubble, and then the day after the gas bubble has flattened the retina use laser photocoagulation to laser around the tears and to keep them closed permanently. Pneumatic retinopexy is limited to very specific instances particularly when the retinal hole is either a single hole or several holes close together and are in the superior portion of the eye.
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Pneumatic Retinopexy Gas is injected into the eye and the patient positioned to "put the bubble on the trouble", flattening the retina. Cryopexy (freezing treatment) or laser is applied around the tear to cause permanent attachment. |
In other instances, a procedure called scleral buckling is necessary to reattach the retina. In a scleral buckle a soft silicone band is placed around the eye, much like a belt around your waist, and is sutured onto the eye using special sutures. The buckle is tightened to give pressure from the outside toward the inside, effectively decreasing the diameter of the eye in the area of the scleral buckle. By this method, the retinal holes on the inside of the eye are closed, allowing the retina to reattach. Many times scleral buckling is accompanied by subretinal fluid drainage and/or a gas bubble injection to aid in reattachment of the retina.
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Scleral Buckling A band of soft silicone is placed around the eye to indent the outside of the eye against the inside, closing the hole. Cryo or laser is applied for adhesion. |
The final surgery sometimes necessary for the repair of a retinal detachment is a vitrectomy, which is described in a separate section of this website. In this procedure a pars plana vitrectomy is performed to remove the vitreous jelly. Special fluid, Perfluoron, may be used to push the retina back into position, and then laser photocoagulation or cryotherapy may be done to cause permanent reattachment of the area around the hole. Scleral buckling may be performed at the same time, based on the specific tears and configuration of the retinal detachment, and if scar tissue called proliferative vitreoretinopathy is present other maneuvers may be necessary.
The success of repairing a retinal detachment is very high and in the majority of instances there is a 90-95% chance of repairing the retinal detachment without further surgery. However, in some instances, particularly with the formation of scar tissue (PVR), further surgery may become necessary. The complications of retinal detachment surgery include infection, hemorrhage, recurrence of the detachment, scar tissue formation, increased pressure in the eye, and other problems. The specific technique used in each case varies based on the configuration of the retinal detachment, the location of the retinal holes, and other factors such as the patient’s health and ability to position postoperatively.
Fortunately, most retinal detachments are repaired with return of sight, especially if caught before the macula (center of vision) detaches. Retinal detachments were a blinding condition not too many years ago but now are routinely repaired in most patients.
Disclaimer Stuff: The opinions expressed in this website are those of RVT. Diagnosis and therapy should be based on a thorough examination by and recommendations of a qualified eye provider.