Retinal Detachment

The retina lines the inside of the eye. It is the important light-sensitive membrane which converts light into nerve signals which are then sent to the brain along the optic nerve. It is an extra-ordinarily delicate tissue which can easily be damaged leading to permanent loss of vision.

Retinal detachment is a serious eye condition which must be treated in a timely fashion to prevent loss of eye sight. Most patients with retinal detachment have had a posterior vitreous detachment (see PVD section) shortly before the onset of retinal detachment. Patients with symptoms of PVD need urgent assessment to rule out the presence of retinal tears or detachment.

Retinal detachment is relatively rare but there are circumstances where the risk of retinal detachment is increased. This is the case in patients who are very short sighted (myopic) and in patients who have had recent cataract surgery or YAG laser capsulotomy (see A-Z guide). Some patients have abnormal areas in the retina which can make retinal tears more likely such as ‘lattice’ or ‘snail-track’ degeneration (see image below).

Currently there is no effective treatment to prevent retinal tear formation or retinal detachment. Recognition of symptoms and prompt referral to an eye surgeon who specializes in diseases of the retina is the only effective way to minimise potential damage from retinal detachment.

Symptoms

Some patients have warning symptoms of flashes and floaters in their vision before the onset of retinal detachment. These should not be ignored and require urgent assessment by an ophthalmologist.

When retinal detachment occurs fluid passes from the vitreous cavity through a break in the retina to cause it to peel away from the inner wall of the eye. This causes a shadow in your vision (often see as a ‘veil’) that can progress rapidly in many cases. When the macula is involved the central vision drops immediately and the eye has a higher risk of losing vision permanently.

Some cases of retinal detachment are accompanied by bleeding from the vessels at the torn edge of the retina. This explains the sudden appearance of floaters which patients often report.

There are some patients who have different causes of retinal detachment that have no obvious warning symptoms such as floaters. Development of a shadow in the peripheral vision of one eye needs urgent assessment.

Trauma is an uncommon cause of retinal detachment and most cases happen spontaneously with no obvious cause.

At the Eye Clinic

You should be assessed by staff at the eye clinic without delay. Eye drops are used to dilate the pupils of both eyes and careful examination of the retina is carried out. If there are retinal tears or detachment you will need to see a specialist retinal surgeon who can advise you of the best treatment for your problem.

The urgency of treatment depends on the degree of retinal detachment. No patient should wait more than a few days for surgery but there are some urgent cases that should undergo surgery within 24 hours, if possible. This is especially true if the macula has not detached and all efforts will be made to offer treatment before this occurs.

Surgery for retinal Detachment

There are a number of options for surgery but your treatment will be discussed with you in detail with your retinal surgeon.

1. Laser photocoagulation. If you have a retinal tear without detachment you will probably require laser treatment to create a “spot-weld” on the retina and prevent detachment. Depending on the location of the tear this may be carried out in the out patient clinic or in the operating theatre. Laser treatment is usually undertaken using local anaesthetic drops.

   

2. Cryotherapy. This is a freezing treatment that has similar effects as laser photocoagulation but will require formal anaesthesia (local or general).
3. Vitrectomy with laser and gas injection. This operation is increasingly recommended by retinal specialists for retinal detachment. It allows very precise microsurgery to remove vitreous jelly from the eye, suck fluid out from underneath the retina through the retinal tear before applying laser to seal the retinal tears and stick the retina back in place. Most patients will have a gas injection at the end of surgery to prevent recurrent detachment while the laser treatment takes effect. While there is gas in the eye vision will be poor and patients should not be alarmed about this. Different gases are used which can remain in the eye for from 2 weeks to 2 months. The gas acts to push the retina into position while the laser ‘glue’ sets. Complications of surgery include failure to reattach the retina requiring re-operation (about 10% of cases) and cataract formation. Other problems are very rare.
4. Scleral Buckle. This operation has been the more traditional type of procedure for retinal detachment. It is effective in many cases and remains the treatment of choice for some types of retinal detachment. The operation involves stitching a piece of silicone plastic (the Buckle) to the wall of the eye, using cryotherapy to make the retina sticky. There may be a gas injection for some cases. The procedure has a high success rate (80 to 90 %) and is usually reasonably comfortable. Complications of surgery include failure to re-attach the retina, eye lid swelling and double vision (usually temporary).
5. Pneumatic retinopexy. This is a smaller operation often carried out in the USA. It is minimally invasive and involves application of cryotherapy to the eye together with a gas injection. Special positioning is required after surgery for a few days but side effects are not common. The operation is associated with a much lower success rate than full surgery (about 60%) and is not popular in the UK. Occasionally it is used after a scleral buckle if the retina does not settle quickly.

There are many options for the treatment of retinal detachment and your retinal surgeon will advise you on the best course of action. Some patients require more than one operation but it is unusual to have a complete failure of surgery (about 1-2 % of cases).

Treatment of retinal detachment is extremely important in all cases. Success might mean a return to normal vision but in other cases only peripheral vision is restored. This often depends on the speed with which a patient comes to their specialist but also is related to the complexity of the retinal detachment itself. It should be remembered that retinal detachment can happen to the other eye in about 15% of patients and it is for this reason that all patients with retinal symptoms in their second eye should have urgent reassessment.