Retina is the light sensitive inner layer of the eye where the images are shaped and are later relayed to the brain. This is similar to the photographic film of a camera, and is very essential for vision. Retinal detachment is a situation in which the Retina separates from the underlying layer and therefore loses its functional ability. A retinal detachment, leads to a sudden and severe loss of vision, and if not treated correctly can source blindness and disfiguring and shrinking of the eye.
What causes Retinal Detachment?
usually, retinal detachment happens due to a tear/ hole creation in the retina. Through this hole, liquefied vitreous, this is jelly like material filling the eyeball, passes behind the retina and detaches it. Tractional retinal detachment generally happens in vascular diseases of the retina or diabetics. Wide membranes are created on the retina, which on constricting, pull the retina up.
What are the risk factors for the development of retinal detachment?
1) existence of high degrees of myopia or minus power,
2) Trauma to the eye, incidence of retinal detachment in the other eye, incidence of retinal detachment in relatives
3) cataract surgery etc. are some of the factors that enhance the risk of retinal detachment.
What can be done to prevent retinal detachment?
If one has any of the above discussed risk factors, she/he should get regular retinal checkups. The pupils are dilated and the retina, particularly the peripheral part, is checked carefully with the help of Indirect Ophthalmoscope. In case a retinal lesion or break is discovered, it can be treated by a simple precautionary procedure of Laser.
What are the symptoms of Retinal Tear or Retinal Detachment?
1) Sudden Flashes of light, or sudden onset of Floaters are ordinary symptoms which may point towards the existence
of Retinal Detachment or a Retinal Tear.
2) A loss of field of vision or unexpected lessen in central vision are symptoms of Retinal Detachment. The diagnosis is
definite by a detailed retinal checkup by a retinal specialist. In the case of reduced vision, B-scan Ultrasound examination
may be essential to verify the identification.
Why the early recognition and diagnosis important?
When the retina gets detached for a long time, it starts to shrink and membranes form on it. This not only needs a major surgery, it also reduces the chances of vision improvement. Additionally, as the retina got detached longer, it doesn’t get sufficient blood supply and thus loses the vision possible. This limits the crucial gain of vision even after a successful reattachment of the retina.
What is the treatment?
1)A retinal tear without a detachment can be treated by a simple Cryopexy or Laser procedure.
2)However a retinal detachment needs a major surgery to settle the retina.
Retinal Surgery
In special cases, this comparatively simpler surgery known as Scleral buckling is done; a silicon band is implant on the exterior of the eye and stitched in place (the scleral buckle is very small and not visible after surgery). It pushes the sclera toward the tear in the retina and closes it to settle the retina.
Vitro- Retinal Surgery
In other severe or complex cases, with the Scleral buckling also, vitrectomy may be needed. In this procedure, the vitreous gel is detached using special instruments, and then retina is settled in place and is fixed there with the aid of laser. To hold the retina or special Gas or Silicone oil is injected in the eye to substitute the vitreous. This oil is inert in nature and is normally removed later at a appropriate time after the preliminary surgery.
What are the precautions after surgery?
Post-operatively, the patient may be required to be maintained in a particular position to support the retina. This is specially necessary in the cases of Vitreo-retinal surgeries. in the follow up visits, additional laser treatments can be advised. As it is a major surgery, some of the patients may also increase complications like corneal opacity glaucoma, infection, cataract, etc. due to the detachment or due to the treatment. The associate eye is also at a risk for future retinal detachment and must be checked at regular basis. Hence a regular follow up is very essential.
Can the retina Re-Detached ?
In some of the patients re-detachment may take place due to creation of membranes on the retina which is called as Proliferative Vitreo Retinopathy. moreover in 20 to 30% of the patients who is operated for Vitreo-retinal surgery, or retinal detachment may reappear after the exclusion of Silicone Oil. Hence it is mandatory to maintain Regular post-operative follow up for a long time even after the surgery.