What is retinal detachment?
Retinal Tear and Retinal Detachment; The thin nerve layer that surrounds the inner surface of the eye like a sheet and creates visual signals is called the retina. The gel substance that fills the inside of the eye is called the vitreous.
The vitreous is normally attached to the retina. With increasing age, the gel substance liquefies and shrinks. When these changes reach a certain stage, the gel substance begins to separate from the retina.
As the vitreous separates, it makes retraction on the retina from the places where it is tightly adhered. Retinal separation is mostly due to the tear that occurs in the retina and the leakage of fluid under the retina from this tear.
Retinal detachment, on the other hand, is a disease that occurs as a result of the separation of the retina from the tissue to which it is attached. In retinal detachment, the nutrition of the retina is impaired and if not treated quickly, vision loss becomes permanent. So it can cause blindness. Therefore, retinal detachment is a disease that requires urgent treatment.
What are the causes of retinal detachment?
There are 3 types of retinal detachment according to the way it occurs.
- Rhegmatogenous retinal detachment: This is the most common type. The gel fluid (vitreous) that fills the cavity of the eye liquefies and shrinks due to age or trauma. During this shrinkage, a hole or tear can occur in the retina. If this tear is not noticed and treated and fluid enters through the hole, the retina may detach. We call this condition rhegmatogenous retinal detachment.
- Tractional retinal detachment: In diabetes, trauma or some eye diseases, intraocular tractional membranes occur. These membranes can pull and detach the retina.
- Exudative (serous) retinal detachment: Excess fluid flows through the vessels under the retina, often for reasons such as eye inflammation or trauma. This causes fluid accumulation under the retina and detachment of the retina. There are no tears or holes in this type of detachment.
What are the symptoms of retinal detachment?
There is no pain in retinal detachment. Appearance of black spots such as incipient flying flies, cobweb-like shadows or gauze-like images can be signs of retinal detachment. Especially when these complaints are accompanied by flashes of light, it is a symptom that increases the possibility of detachment.
When the retina detaches, there is a narrowing in the visual field, as if the curtain is closing on one side. As the disease progresses, vision may be completely lost. If these complaints develop, an ophthalmologist should be consulted urgently.
How to diagnose retinal tear and detachment:
The patient’s pupils are dilated with the help of drops, and retinal examination is performed with the help of a device called a biomicroscope. In this way, the hole, tear and detachment area in the retina are determined. Sometimes intraocular hemorrhage may also occur and make direct examination difficult. In such cases, an eye ultrasound may be required.
What are the risk factors for retinal detachment?
- Age
- Eye surgeries in the past (such as cataract surgery)
- Trauma
- High myopia
- Prior retinal detachment in one eye
- Presence of thinning areas in the retina
How to treat retinal tear and detachment:
Retinal Laser:
Detachment treatment with laser is a very easy procedure that can be done in the outpatient clinic. If tears are detected before detachment develops, then laser treatment is applied around the tears and the development of detachment is prevented.
Therefore, early diagnosis is very important. If the liquid has passed under the retina, it means that the laser treatment phase has passed and the surgery has become mandatory.
Surgical Treatment:
If the detachment has developed, the only option is surgical treatment. Various methods can be applied in surgical treatment according to the clinical picture.
These are gas injection into the eye and laser, scleral buckling surgery and vitrectomy surgery. The aim in all of them is to remove the fluid that causes the detachment, to soothe the retina and to close the tears.
By injecting gas into the eye, more fluid from the tear is prevented from entering, and laser or cryotherapy is performed around the tear by soothing the retina. It can be applied in certain cases caught early.
In the treatment of buckling, the tear is closed by buckling the eye from the outside with a silicone band from the outside without entering the eye, and laser or cryotherapy is applied to ensure the adhesion of the tears. It is advantageous not to enter the eye and to protect the intraocular structures. However, it may not be appropriate in advanced cases.
Vitrectomy surgery is the most commonly used method in the treatment of detachment today. In vitrectomy surgery, very small holes are made in the eye and the eye is entered.
The eye gel is cleaned, the fluid under the retina is drained, and laser is applied around the tears. In this surgery, all tractions can be cleaned and tears or small holes that may be missed out in other methods can be detected and treated.
At the end of the surgery, gas or silicone is injected into the eye. The purpose of this is to prevent the tears from reopening until they are permanently adhered.
What should be the expectation after retinal detachment surgery?
Retinal detachment is a disease that causes blindness if it is left untreated. Although it can be treated with 90% success by surgery today, a second surgery may be required in some cases.
Despite this high success rate, the increase in vision is not always predictable. The increase in vision can sometimes last for months or even 1-2 years.
The most important factor affecting surgical success and increase in vision is the time elapsed between the onset of the disease and the surgery. Therefore, early diagnosis and treatment is very important in this disease.