Retinal Detachment

with Dr. Raphael Rosenbaum

Retinal Detachment

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What is retinal detachment?

The retina is the light-sensitive nerve layer that lines the inside of the eye.  It is responsible for sending visual messages to the brain via the optic nerve.  A retinal detachment leads to retinal ischemia if not repaired promptly.  The ischemia results from a lack of nutritional supply from the underlying blood vessels.

What are the different types of retinal detachment?

There are three types of retinal detachment.  The most common is a Rhegmatogenous retinal detachment.  This occurs when there is a tear in the retina that allows fluid to go underneath the retina and separate it from its vascular source the retinal pigment epithelium (RPE). The second most common type is a tractional retinal detachment.  This type of detachment occurs when scar tissue on the retina’s surface contracts causing traction thereby detaching the retina from the RPE. The third type of retinal detachment is the exudative type which is least common.  In this type of detachment their is no tear in the retina. Instead, due to ocular inflammation their is buildup of fluid underneath the retina.

Who is at risk for retinal detachment?

Anyone can develop a retinal detachment, but it is more common in people over age 40, men more than women, and Caucasians more than African Americans. Other risk factors include being extremely nearsighted, a history of a detachment in the other eye, a positive family history, having other eye disorders or history of prior eye injury.

What are the signs and symptoms of a retinal detachment?

Common symptoms include an increase in the number of floaters in your vision or having a vail of blurriness come in from the side. A retinal detachment is a medical emergency.

How is a retinal detachment treated?

If the detachment is from a small hole or tear in the retina it may be amenable to treatment in the office with “spot welding.”  This can be accomplished with laser retinopexy or cryotherapy.  If the detachment has progressed it usually needs to be treated in the Operating Room.  Treatment options include scleral buckling with or without a pars plana vitrectomy.  In a scleral buckling procedure a tiny synthetic band is attached to the outside of the eye, gently reapproximating the detached retina.  In a vitrectomy a small incision is made in the white part of the eye and a roto-rotor like instrument is used to remove the tractional bands in order to reattach the retina.  Often after any retinal surgery an expansile gas is injected to into the eye; the gas gently pushes the retina back against the wall of the eye.

With current therapy, over 90 percent of retinal detachments can be successfully treated, although sometimes a second surgery is needed. Unfortunately, the final visual outcome is not always predictable. The patient may need several months of healing time before they get there best visual acuity.  Regrettably, even under the best of circumstances,  treatment sometimes fails and vision may be permanently lost.