Discover the best treatment options for retinal detachment in our comprehensive guide of Meri sehat . From surgical to non-surgical approaches, we've got you covered.

Retinal Detachment

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Retinal detachment or a detached retina is a major eye condition wherein the retina pulls away from its normal position at the back of the eye. It can lead to vision loss if it&rsquo;s not timely addressed. 
&nbsp;

Retinal detachment is a medical emergency in which the retina pulls away from the tissue around it. It is characterized by the sudden appearance of flashes of light and floaters along with reduced vision.

A meta-analysis of studies in Europe stated that the average incidence rate of retinal detachment in the region is around 13.3/100,000.<a href="#accordion">[5]</a> It is considered a medical emergency, i.e., the longer the condition remains untreated, the higher the risk of permanent vision loss in the impacted eye. 
&nbsp;

Retinal detachment can be divided into three categories: 
&nbsp;

<ol>
	<li>
	<h5>Rhegmatogenous</h5>
	</li>
</ol>

A cut in the retina allows fluid to flow through and gather beneath the retina. The accumulated fluid causes the retina to move away from the underlying tissues. When the retina breaks away, it ends up losing blood supply and ceases to work, which results in vision loss.<a href="#accordion">[3]</a> 
&nbsp;

<ol start="2">
	<li>
	<h5>Tractional Retinal Detachment</h5>
	</li>
</ol>

This type of retinal detachment occurs when scar tissue on the surface of the retina grows and causes the retina to drift away from the rear of the eye. 
&nbsp;

<ol start="3">
	<li>
	<h5>Exudative</h5>
	</li>
</ol>

The term refers to retinal detachment due to fluid accumulation beneath the retina even though there are no tears or holes in the retina. 
&nbsp;

Signs and Symptoms

Retinal detachment is rarely painful. The signs and symptoms depend on the extent of the detachment &mdash; they&rsquo;re more likely to develop if a relatively large part of the retina breaks away and, at the other extreme, may not present at all if only a small part of the retina detaches. 
&nbsp;

The symptoms of retinal detachment often appear suddenly and include:<a href="#accordion">[6]</a>

<ul>
	<li>Photopsia or flashes of light in one or both eyes</li>
	<li>A lot of new floaters (specks or threads in the vision) at once</li>
	<li>A shadow appearing in the side or peripheral vision</li>
	<li>A shadow or &ldquo;curtain&rdquo; over the field of the vision 
	&nbsp;</li>
</ul>

Note:&nbsp;Consult your eye doctor immediately if you have any of the symptoms stated above. 
&nbsp;

Causes

<ul>
	<li>
	<h5>Rhegmatogenous Retinal Detachment</h5>
	</li>
</ul>

Aging is the most common cause of rhegmatogenous detachment. The vitreous, a thick, jelly-like substance in the eyeball, alters or shrinks in consistency.<a href="#accordion">[2]</a>

It is common for the vitreous to separate from the surface of the retina without any complications &mdash; a condition known as posterior vitreous detachment (PVD). However, it can also lead to complications, like a retinal tear. This happens when the vitreous separates or peels away forcefully due to trauma, nearsightedness, or surgery.<a href="#accordion">[1]</a> 
 
If this tear is not treated promptly, the liquid vitreous will leak into the space behind the retina, causing the retina to separate from the surrounding tissue. 
&nbsp;

<ul>
	<li>
	<h5>Tractional Retinal Detachment</h5>
	</li>
</ul>

This type of retinal detachment occurs when diabetes starts to affect the retinal vascular system. It leads to the formation of scar tissue on the retina, which causes it to pull away from the back of the eye.<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>
	<h5>Exudative Detachment</h5>
	</li>
</ul>

There are no tears in the retina. However, fluid accumulates beneath the retina due to eye injury, inflammation, and age-related macular degeneration, causing swelling and leaky vessels. 
&nbsp;

Diagnosis

Retinal detachment is suspected in all patients, but more so if they are at risk, i.e., they present with symptoms, like photopsia, sudden change or an increase in floaters, or any sudden and unexplained loss of vision.

The doctor will ask the patient about the symptoms and their duration. They&rsquo;ll also want to know if there&rsquo;s any history of trauma or surgery, or if the patient&rsquo;s been diagnosed with any other eye conditions as well like uveitis or vitreous hemorrhage that puts them at risk of having a retinal detachment.

Since seeing a detached retina from the outside is impossible, the doctor will perform a comprehensive eye exam to screen and diagnose the condition. Eye drops are used to dilate the pupils to look for retinal tears. In case the doctor needs to look at the retina in more detail, they&rsquo;ll order further tests. These tests are non-invasive and, ideally, should not hurt:

<ul>
	<li>Fluorescein Angiography &ndash; checking blood flow in the retina using a special dye and camera</li>
	<li>Ophthalmoscopy &ndash; checking the back part of the eye, which includes the retina</li>
	<li>Tonometry &ndash; checking the pressure inside the eye</li>
	<li>Color Vision</li>
	<li>Visual Acuity &ndash; checking the smallest letters the patient can read</li>
	<li>Slit-Lamp Exam &ndash; checking the structure at the front of the eye</li>
</ul>

&nbsp;

<h5>Retinoscopy</h5>

This checks the refractive error of the eye. A retinoscope is used to shine a beam of light into the patient&rsquo;s eye while the examiner looks at the movement of the light reflected from the back of the eye.

The test is then repeated with the doctor holding lenses in front of the eye and as the power of the lens changes, there&rsquo;s a marked change in the direction as well as the pattern of the light reflection. 
&nbsp;

<h5>Ultrasound Imaging</h5>

This exam is ordered when there&rsquo;s bleeding in the eye, which makes it difficult for eye specialists to see the retina.

These tests, including retinoscopy and ultrasound, are important to ensure the symptoms have not developed due to:

<ul>
	<li>Posterior uveitis</li>
	<li>Posterior vitreous detachment</li>
	<li>Retinal vein occlusion</li>
	<li>Retinal artery occlusion</li>
	<li>Migraine with or without aura</li>
	<li>Vitreous hemorrhage 
	&nbsp;</li>
</ul>

Note: The doctor will examine both eyes even if you present with symptoms in just one eye. If no tear is found during the first visit, the doctor will ask you to come back after a few weeks to confirm that the vitreous separation does not lead to a delayed tear.<a href="#accordion">[6]</a> 
&nbsp;

Treatment

Surgery is needed to fix a retinal tear or to reattach the retina to the back of the eye. The type of surgery depends on the type of retinal detachment and the degree of retinal detachment.<a href="#accordion">[7]</a> 
&nbsp;

<ol>
	<li>
	<h5>Retinal Tear</h5>
	</li>
</ol>

The following procedures can help prevent retinal detachment and protect eye vision if the tear is not at an advanced stage: 
&nbsp;

Photocoagulation

Laser is directed into the eye to burn around the retinal tear. This creates scars that help &ldquo;weld&rdquo; the retina to the tissue. 
&nbsp;

Cryopexy

Cryopexy or freezing is another alternative. In this case, the surgeon applies a freezing probe to the outer surface of the eye making sure that it&rsquo;s directly over the retinal tear. The freezing creates scarring that repairs the tear and secures the retina. 
&nbsp;

<ol start="2">
	<li>
	<h5>Retinal Detachment</h5>
	</li>
</ol>

Surgery to reattach the retina depends upon how severe the detachment is. 
&nbsp;

Pneumatic Retinopexy

Pneumatic retinopexy is recommended to fix slight detachments. A bubble of air is injected into the vitreous cavity and it pushes the part of the retina with tears against the eye wall.

This stops the leak into the space behind the retina. The fluid that has already accumulated under the retina is reabsorbed by the body and the retina attaches to the wall of the eye. The bubble, too, reabsorbs on its own with time.

Note: To prevent unnecessary straining of your eye while healing, make sure you:

<ul>
	<li>Avoid strenuous exercise</li>
	<li>Traveling in an airplane</li>
	<li>Lifting heavy objects</li>
	<li>Do not skip any follow-ups 
	&nbsp;</li>
</ul>

Scleral Buckling

The surgeon may opt for scleral buckling in more extreme situations of retinal detachment. During the procedure, a piece of silicone material is sewn onto the sclera over the affected part. This relieves some tension that may have occurred due to vitreous tugging on the detached retina.

In case there are multiple tears or extensive detachment, the surgeon creates a scleral buckle to go over the eye like a belt. Since it remains there permanently, the doctor will ensure it does not block the patient&rsquo;s vision. Additionally, a laser or freezing technique may be employed to seal the tear.

Note: To ensure that your eye heals permanently after multiple surgeries, you should:

<ul>
	<li>Wear an eye patch for at least 24 hours following the procedure</li>
	<li>Ignore any strenuous exercise</li>
	<li>Make an appointment with your doctor for a check-up 
	&nbsp;</li>
</ul>

Vitrectomy

Vitrectomy is for relatively large tears. The surgeon removes the tissue that&rsquo;s pulling at the retina along with the vitreous. Then, either silicone oil or gas is injected into the vitreous space until the retina is completely flattened.

The procedure is usually combined with scleral buckling. With time, this gas is reabsorbed and the cavity is refilled with the body fluid; silicone oil, however, will have to be surgically removed several months after vitrectomy.

Note: Follow your doctor&rsquo;s instructions regarding any activity, such as flying or traveling to high altitudes, that you wish to pursue following the surgery. 
&nbsp;

Retinal detachment is a major eye problem that may give rise to several health problems if left untreated or treated late. 
&nbsp;

<ol>
	<li>
	<h5>Vision Loss</h5>
	</li>
</ol>

If the detachment is not treated immediately, it can cause permanent retinal damage and irreversible loss of sight in the impacted eye. 
&nbsp;

<ol start="2">
	<li>
	<h5>Proliferative Vitreoretinopathy</h5>
	</li>
</ol>

This is a problem that arises when scar tissue develops in the eye following a retinal detachment. Scar tissue can drag on the retina and cause it to separate again, resulting in further visual impairment. 
&nbsp;

<ol start="3">
	<li>
	<h5>Macular Detachment</h5>
	</li>
</ol>

The macula is the central portion of the retina that is in charge of central vision. A detached macula during a retinal detachment can cause significant loss of central vision. 
&nbsp;

<ol start="4">
	<li>
	<h5><a href="https://merisehat.pk/disease/cataract">Cataracts</a></h5>
	</li>
</ol>

Cataracts are a frequent side effect of retinal detachment surgery, resulting in vision issues and necessitating cataract surgery. 
&nbsp;

<ol start="5">
	<li>
	<h5>Infection</h5>
	</li>
</ol>

In rare cases, eye infection occurs as a complication of retinal detachment surgery and can result in loss of vision. 
&nbsp;

Important!

To reduce the possibility of complications and to protect your vision, contact your doctor right away if you notice any of the signs of retinal detachment. 
&nbsp;

While anybody can develop retinal detachment, some are more likely to develop the condition due to the following risk factors:<a href="#accordion">[6]</a>

<ul>
	<li>Genetics (family history of retinal detachment)</li>
	<li>A previous eye injury</li>
	<li>A previous retinal detachment in one eye</li>
	<li>A previous eye surgery (for example, to treat cataracts)</li>
	<li>Certain eye conditions, including diabetic retinopathy, <a href="https://merisehat.pk/disease/myopia">myopia</a>, and lattice degeneration</li>
	<li>Age (over 50) 
	&nbsp;</li>
</ul>

It is not possible to prevent retinal detachment. However, some precautions can lower the risk of retinal detachment induced by injury or illness. These include:

<ul>
	<li>Wear protective glasses, especially while engaging in athletic activities, performing heavy lifting, or using devices</li>
	<li>Maintain blood sugar under control</li>
	<li>&nbsp;Get regular eye exams 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Retinal detachment is a medical emergency in which the retina &ndash; a thin coating of tissue at the rear of the eye &ndash; pulls away from the tissue around it.</li>
	<li>It is characterized by the sudden appearance of flashes of light and floaters along with reduced vision.</li>
	<li>Retinal detachment can be triggered by various conditions, including trauma, aging, nearsightedness, diabetes, and other eye problems.</li>
	<li>Intervention for retinal detachment usually includes surgical procedures, including vitrectomy, scleral buckle, or pneumatic retinopexy to reattach the retina and help stop additional loss of vision.</li>
	<li>Early detection and treatment are critical in preventing permanent vision loss.</li>
</ul>

[1] Gonin J. The treatment of detached retina by searing the retinal tears. Arch Ophthalmol. 1930;4(5):621–5.

[2] Govers BM, van Huet RAC, Roosing S, Keijser S, Los LI, den Hollander AI, et al. The genetics and disease mechanisms of rhegmatogenous retinal detachment. Prog Retin Eye Res. 2023;101158.

[3] Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. 1982;100(2):289–92.

[4] McCullough P, Mohite A, Virgili G, Lois N. Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2023;

[5] Madi HA, Keller J. Increasing frequency of hospital admissions for retinal detachment and Vitreo-Retinal Surgery in England 2000–2018. Nature News.