Retinal Detachment

 Retinal detachment is a disorder of the eye, in which the retina is detached from the underlying layer of tissue called choroid. Initially this detachment may be local, but without immediate treatment, the entire retina can be detached and lead to loss of vision and blindness. It is considered an emergency medical situation.

Types of detachment

Rhegmatogenous retinal detachment: it is caused by a tear in the retina, which allows fluid to pass under it and detach it from the choroid. Exudative retinal detachment: it is caused by inflammation or vascular diseases that allow for fluid accumulation without a tear. Tractional retinal detachment: Due to inflammation or neovascularization (e.g. diabetes), fibrous tissue can create traction on the retina.

Causes

Risk of detachment in otherwise normal eyes is about 5 for every 100,000 people a year. Detachment is more frequent in people of middle age or older where the ratio is about 20 in 100,000. Retinal detachment is more frequent with high myopia (over 5-6 diopters) due to longer axial length of the eyes and a thinning of the layer of tissue. Lifetime risk increases in about 1 in 20. Myopia is connected to 67% of detachments and usually involves younger patients. Cataract surgery can also lead to detachment, especially when there have been complications during surgery. Risk increases from 5-16 in 1000 cataract surgeries with a significant rise by 7% in patients with high myopia. Injuries in the eye area can also cause tears, leading as a result to detachment. Finally, tractional detachments are mainly associated with diabetic retinopathy and neovascularization observed in its advanced stages.

Symptoms 

Retinal detachment usually follows after a posterior vitreous detachment that created traction on the retina and presents symptoms such as photopsias (flashes) and floaters (black spots).
Even though most choroid detachments don't lead to retinal detachments, those that do cause the following symptoms: a shadow or curtain in the peripheral visual field that moves slowly towards the center, straight lines that start to seem crooked and central loss of vision.

Treatment 

Laser

Laser is used to close up the tears on the retina. It is used as a preventive measure that will hinder retinal detachment.

Scleral buckling and scleral transplant

During scleral buckling, the surgeon uses a “zone” of silicone that will strap the eyeball form the outside and press the sclera towards the retina. The same function is served by transplants that keep local and exterior pressure in the area of the eyeball where there is tearing and detachment.

Vitrectomy 

During this procedure the cause for detachment, the vitreous, is removed and the retina is flattened using a special heavy fluid and air, while the tears and the detached retina are “glued” with endolaser. In the end, a special gas is inserted, which is absorbed on its own in just a few days, or silicone oil that needs to be extracted after 2-3 months, depending on the case. Vitrectomy is considered by many the best and most appropriate surgical method for detachment.
After surgery, vision will be restored in a period of a few weeks; it will improve gradually, both quantitatively and qualitatively. Vision can be restored completely if the detachment is peripheral, but if the macula is detached, then visual acuity may not be the same as before. Time plays a very important role and that is the reason why the procedure's success is connected to how fast the problem will be treated. It is obvious that if detachment remains untreated, then blindness follows in a matter of days.

Prevention 

Retinal detachment can sometimes be prevented. Floaters and flashes are symptoms that call for immediate communication with our ophthalmologist. Differential diagnosis includes posterior vitreous detachment that does not need treatment, the existence of a tear that needs laser treatment or the existence of an initial retinal detachment that needs emergency surgery.

There are some risk factors and some activities that might lead to detachment. Cataract surgery and especially one with complications might be connected to detachment. Eye injuries, especially form activities related to martial arts (boxing, karate) may cause peripheral tears (dialysis) and lead to detachment.

Those athletes need to be examined by an ophthalmologist often. High myopia can also be a risk factor since it is connected to some peripheral degeneracies that can lead to tears. Ophthalmoscopy, especially of the periphery, to people with myopia can diagnose damage connected to detachment. Bending and lifting weights are not considered on their own (without some other problem or cause) activities that might lead to detachment. On the contrary, intense and frequent eye rubbing and the exercise of mechanical pressure should be avoided.

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