Retinal Detachment

Symptoms

A retinal detachment, should it occur, can be vision threatening. That is why it is important to know the signs and symptoms of a retinal detachment. They are:

• Brief flashes of light in your vision (if you have a known posterior vitreous detachment, watch for increasing frequency of light flashes)
• A sudden shower of new floaters
• A grey or black curtain or shade coming into your vision from any direction
• A new blind spot in your vision
• Blurring of your vision which does not clear with blinking or artificial tears

If you see any of these retinal detachment symptoms, call your private ophthalmologist, go to your local hospital emergency room or the Wills Eye Emergency Room immediately.

Treatment of Retinal Tears to Prevent Retinal Detachments

Usually, retinal tears affect the only peripheral vision. Symptoms include unexplained flashes of light and moving black spots (floaters). If you suspect you have a retinal tear, it is important to see your ophthalmologist as soon as possible.

Sometimes, doctors will simply monitor a retinal tear and elect not to treat it. However, if your retina specialist is concerned that the tear will lead to a retinal detachment, the recommended treatment is either cryosurgery (a "freezing" technique) or laser treatment.

Both cyrosurgery and laser may be performed on an outpatient basis. Cryosurgery involves the use of a local anesthetic to numb the eye. The area around the site of the retinal tear is then frozen using a probe. As the treated area heals, scar tissue is formed which helps to seal the tear. Laser surgery uses an intense but precisely focused beam to form the scar tissue that seals the tear.

Scleral Buckle Surgery for Retinal Detachments

Scleral buckle is a surgical procedure that has been used for more than 30 years. It involves the placement of silicone onto the outer wall of the eyeball to create a buckle effect inside the eye. The buckle pushes against the retinal tear or detachment, helping to push it back into a more normal position. Once the tear is sealed, the eye completes the healing process by resorbing the fluid inside the retina (the subretinal fluid).

Scleral buckle surgery can usually be done under local anesthesia and on an outpatient basis.

Vitrectomy for Retinal Detachments

For certain types of retinal detachments ("traction" retinal detachments and detachments that involve the loss of the natural fluids inside the retina), vitrectomy is a commonly used surgical procedure.

Sometimes referred to as "pars plana vitrectomy or PPV," this procedure was developed about 20 years ago. Small incisions are made to allow access into the center of the eyeball. The surgeon removes the vitreous and repairs the detachment. After surgery, the patient will need to use certain precautions and maintain specific head positions to prevent another retinal detachment. Within days-to-weeks of surgery, the eye will replace its own fluids inside the retina.

Vitrectomy can usually be done on an outpatient basis, under local anesthesia.

Pneumatic Retinopexy for Retinal Detachments

When there is only one defined retinal tear causing detachment, surgeons may elect to use a procedure called pneumatic retinopexy. This procedure may be done in the surgeon's office.

During pneumatic retinopexy, the surgeon injects a gas bubble into the middle part of the eyeball and attempts to cover the tear with the bubble. Using either a freezing technique (cryopexy) or laser, the retinal tear is treated. Within a few days, the retinal tear will seal down on the eye and the fluid under the retina resorb, allowing complete retinal reattachment.

Even though pneumatic retinopexy is a simpler procedure than scleral buckle surgery or vitrectomy, the patient must comply with very specific instructions regarding head position for up to 10 days following surgery or risk another retinal detachment. Furthermore, only certain retinal detachments can be repaired with PR.