RETINAL DETACHMENT
Wills Eye retina doctors are leading experts in the treatment of diabetic retinopathy with the latest therapeutic approaches for this disease.
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What Is Retinal Detachment?
A retinal detachment is a separation of the retina from the underlying layers of the eye wall. The retina is the thin layer of tissue that retains the vision cells in the back of the eye—think of it as 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. Over time, retinal detachment will lead to progressive loss of peripheral and, eventually, central vision. Left untreated, total and permanent loss of sight eventually occurs in most cases.
Retinal Detachment Prognosis & Treatment
EXAMINATION
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. There may also be some degree of vitreous hemorrhage, which occurs when a retinal tear involves a retinal blood vessel.
PROGNOSIS
Retinal detachments often cause some degree of permanent visual field or central visual acuity loss, even after successful reattachment. Final visual outcomes are best if the detachment is detected and treated before it involves the center of the retina (macula). A change of eyeglasses after retinal detachment surgery may or may not improve vision. Longstanding retinal detachments or those with associated scar tissue (proliferative vitreoretinopathy) typically have a poor visual prognosis.
TREATMENT
If a retinal hole or tear is detected before there is retinal detachment, laser or cryotherapy (freezing treatment) to the retinal tear is often successful in sealing the retinal defect, preventing a retinal detachment. However, if a retinal detachment has already developed, a retinal reattachment procedure is typically necessary.
Retinal Detachment Surgery
There are three approaches to repairing a retinal detachment: The choice of treatment depends on certain features of the detachment such as number and location of retinal tears as well as patient characteristics such as age and past cataract surgery.
Pneumatic Retinopexy
This office-based procedure involves the injection of a temporary gas bubble to close the retinal tear and surrounding detachment. The gas injection is coupled with either a freezing treatment (cryotherapy) or laser photocoagulation to permanently seal the causative retinal tear. After the procedure, patients must maintain a specific head position for about a week to ensure that the retinal tear is adequately sealed.
Scleral Buckle Surgery
Performed in the operating room, scleral buckle surgery consists of suturing a soft piece of silicone to the eye wall (sclera) in such a way as to gently indent the sclera in order to support and close the retinal tear. It is coupled with either cryotherapy or laser treatment. Drainage of subretinal with or without gas bubble is sometimes used to facilitate reattachment of the retina. In some cases, a scleral buckle may be combined with vitrectomy surgery.
is also performed in the operating room. As the name implies, it involves surgical removal of the vitreous gel which, in turn, relieves the traction or pulling on the retinal tear that is causing the detachment. Laser is then used to seal the retinal tears. Lastly, the eye is filled with either gas or silicone oil. Gas goes away slowly on its own, but oil does not. Silicone oil may be removed at a later date with another vitrectomy. (The use of silicone oil is usually reserved for complex retinal detachments such as those with associated scar tissue or very large retinal tears.)
Wills Eye Retina Doctors
