The retina is like the film inside a camera. The image that one sees is focused by the lens and cornea in the front of the eye and then cast upon the center of the retina macula in the back of the eye. A retinal detachment is a separation of the retina from the underlying layers of the eye wall. This will lead to progressive loss of peripheral and, eventually, central vision. Left untreated, total, permanent loss of sight eventually occurs in most cases.
A rhegmatogenous type of retinal detachment is caused by a break, tear or hole in the retina, allowing fluids from the vitreous cavity of the eye to track under the retina and detach it from the eye wall. Rhegmatogenous retinal detachment is the most common type or retinal detachment. Retinal tears and associated detachments of the retina are usually spontaneous events and cannot be predicted.
It is caused by the vitreous gel separating from the retina. Over time as one grows older, the vitreous gel liquefies.
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It eventually collapses upon itself and separates from the surface of the retina. During or shortly after this event, a retinal tear can occur by the gel pulling on the retina. Risk factors for developing retinal tears and detachment include myopia near-sightedness , thin patches of the peripheral retina lattice degeneration , previous eye surgery, and trauma.
These symptoms usually reflect the vitreous gel separation and retinal tear event. The rate of progression of the retinal detachment can vary from days to weeks depending on many factors such as patient age and size and number of retinal tears. A comprehensive ophthalmic examination is essential to diagnose and treat a retinal detachment. Through a dilated pupil, the ophthalmologist will see one or more tears in the retina with varying amounts of underlying fluid.
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There may also be some degree of vitreous hemorrhage. Hemorrhage is common when the retina tears.
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Retinal detachments often cause some degree of permanent visual field or central visual acuity loss, even after successful retinal reattachment. Final visual outcomes are best if the detachment is detected and treated before it involves the center of the retina macula. Longstanding retinal detachments typically have a poor visual prognosis.
A change of glasses after healing from retinal detachment surgery may or may not improve the vision. If a retinal break or tear is detected before there is retinal detachment, laser or cryotherapy freezing to the retinal tear is often successful in sealing the tear and preventing a retinal detachment. Radial scleral buckle is indicated for U-shaped tears or Fishmouth tears, and posterior breaks.
Circumferential scleral buckle is indicated for multiple breaks, anterior breaks and wide breaks. Encircling buckles are indicated for breaks covering more than 2 quadrants of retinal area, lattice degeneration located on more than 2 quadrant of retinal area, undetectable breaks, and proliferative vitreous retinopathy. This operation is generally performed in the doctor's office under local anesthesia.
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It is another method of repairing a retinal detachment in which a gas bubble SF 6 or C 3 F 8 gas is injected into the eye after which laser or freezing treatment is applied to the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole. Patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole.
This strict positioning requirement makes the treatment of the retinal holes and detachments that occurs in the lower part of the eyeball impractical. This procedure is usually combined with cryopexy or laser photocoagulation. Pneumatic retinopexy has significantly lower success rates compared to scleral buckle surgery and vitrectomy.
Some initially successful cases will fail during the weeks and months after surgery. A recent Cochrane Review compared outcomes from patients receiving retinal reattachment from pneumatic retinopexy versus scleral buckle. Vitrectomy is an increasingly used treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble SF 6 or C 3 F 8 gas or silicone oil PDMS. An advantage of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks.
PDMS, if used, needs to be removed after a period of 2—8 months depending on surgeon's preference.
Silicone oil is more commonly used in cases associated with proliferative vitreo-retinopathy PVR. A disadvantage is that a vitrectomy always leads to more rapid progression of a cataract in the operated eye. In many places vitrectomy is the most commonly performed operation for the treatment of retinal detachment. A recent Cochrane Review assessing various tamponade agents for patients with retinal detachment associated with PVR found that patients treated with C 3 F 8 gas and standard silicone oil had visual and anatomic advantages over patients using SF 6.
After treatment patients gradually regain their vision over a period of a few weeks, although the visual acuity may not be as good as it was prior to the detachment, particularly if the macula was involved in the area of the detachment. Until the early 20th century, the prognosis for rhegmatogenous retinal detachment was very poor, and no effective treatments were available. Currently, about 95 percent of cases of retinal detachment can be repaired successfully. Involvement of the macula portends a worse prognosis. It is not clear if surgery is beneficial for asymptomatic retinal breaks or lattice degeneration.
The incidence of retinal detachment in otherwise normal eyes is around 5 new cases in , persons per year. From Wikipedia, the free encyclopedia. Retinal detachment Other names Detached retina Slit lamp photograph showing retinal detachment. Play media. BMJ Clinical Evidence.
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