Retinal Detachment

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Treatment

Surgical treatment for retinal detachment depends on type, severity, and location of the detachment. Risks include infection, bleeding, cataract development, and increased pressure inside the eye. However, without intervention, retinal detachment usually causes permanent partial vision loss or blindness.

The retina can be repaired in about 90% of cases. Approximately 33% of patients with a successfully reattached retina have excellent vision within 6 months of surgery. Others achieve various degrees of vision. The success of surgery depends on the size and location of the damage, the length of time between the onset of detachment and the attempt to repair it, and other complicating factors. Surgery is less effective if the retina has been detached for a long time, if the detachment is severe, or if fibrous tissue has grown on the retina's surface. In a small number of cases, the retina cannot be reattached because of continuous vitreous shrinkage or fibrous growths on the retina.

Laser Photocoagulation
If the retina is torn or the detachment is very slight, a laser can be used to burn the edges of the tear and halt progression. The fine beam of light produces scar tissue that seals (coagulates) the tear and prevents fluid from passing through. If there is a very small detachment, the laser can seal the retina against the choroid. Laser surgery is usually performed as an outpatient procedure, under local anesthesia.

Cryopexy
Cryopexy uses nitrous oxide to freeze the tissue behind the retinal tear, stimulating scar tissue formation that will seal the edges of the tear. It is usually done as an outpatient procedure, under local anesthesia.

Pneumatic Retinopexy
Pneumatic retinopexy is most effective for detachments that occur in the upper portion of the eye. The eye is numbed with local anesthesia and a small gas bubble is injected into the vitreous body. The bubble rises and presses against the retina, pushing it against the choroid. The gas bubble is slowly absorbed over the next 1 or 2 weeks. Cryopexy or laser is used to seal the retina into place.

Scleral Buckle
Scleral buckle treatment is the most common treatment for retinal detachment in adults. It is more invasive than pneumatic retinopexy and the success of the treatment depends on the size and location of the detachment. In this procedure, a tiny sponge or silicon band is attached to the tough outer membrane of the eye (sclera) to press against the retina and hold it in place.

The buckle is not visible and remains permanently attached to the eye, except in the case of an infant when it must be replaced because of eye growth. Because the scleral buckle elongates the eye, the patient may experience myopia. Existing nearsightedness may worsen and existing farsightedness may improve somewhat. Cryopexy or laser photocoagulation is usually performed during scleral buckle surgery.

Vitrectomy
A vitrectomy may be performed if there is a large retinal tear, a retinal detachment involving the macula, or a nonabsorbing vitreous hemorrhage that is interfering with testing or treatment. In a vitrectomy, the vitreous is removed and replaced with air or a saline solution, which exerts pressure that pushes the retina against the wall of the eye. This procedure is usually performed under local anesthesia in an outpatient setting.

In rare cases, silicone oil is used. However, the oil must be removed once the retina is reattached because the oil interferes with vision. A second procedure is needed to replace the oil with air or another fluid.

Prevention

Preventing retinal detachment is possible by having regular eye exams and seeing an eye care practitioner immediately when early symptoms (floaters and flashes) are experienced. In most cases, small tears can be repaired easily and vision can be preserved. People at high risk should discuss the frequency of eye exams with their practitioner.

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