What is the retina?retinal detachment

The retina is a thin layer of cells located in the inner part of the eyeball that is sensitive to light. The eye is a very complex organ, with its component parts working as a whole for us to see. The center of the eyeball contains vitreous fluid, a clear gel that maintains the spherical shape of the eyeball. The vitreous lies between the lens and the retina, the light-sensitive tissue inside the eye.

What is the vitreous?

The vitreous contains millions of fibers interconnected with the retina from birth. As we age the vitreous tends to contract and slowly detach from the retina.

Detached vitreous fibers can cause retinal detachment. Detachment of the vitreous from the retina is a normal process of the eye's aging process.

What is retinal detachment?

Retinal detachment it is the result of the process of separation of the retinal vascular membrane, it being lifted or displaced from its normal position. In some cases there may be only small areas of the retina that are torn called retinal tears, these untreated can lead to retinal detachment. If not treated promptly, retinal detachment can lead to permanent vision loss.

Types of retinal detachment

retinal detachment

There are 3 main types of retinal detachment:

  • rhegmatogenous produced as a result of a retinal break that allows the passage of liquefied vitreous between the pigment epithelium and the retina.
  • tractional in which membranes are formed in the vitreous cavity that pull the retina and detach it.
  • exudative produced by the penetration of fluid under the retina called subretinal fluid.

There is also retinal detachment without retinal tears, called non-rhegmatogenous detachment, which occurs in some inflammatory diseases of the retina or retinal vessels and which generally does not require surgery.

Causes and risk factor

Initially the detachment may be localized but rapidly progresses to complete retinal detachment. Retinal detachment can occur spontaneously or have certain contributing factors, namely:

  • Myopia, strong myopia
  • Family history of retinal detachment
  • Age-related macular degeneration
  • Systemic diseases (eg. Marfan syndrome)
  • Eye trauma

Retinal detachment can also occur in the following cases:

  •  Diabetes mellitus with proliferative diabetic retinopathy where vitreoretinal fibrosis can occur which by pulling on the retina can cause it to detach, producing tractional retinal detachment.
  • Tumors with intraocular development
  • Traumatism of the posterior eye pole
  •  Post-inflammatory connective or fibrovascular structures or post-ocular surgery (eg. Cataract)

Symptoms of retinal detachmentretinal detachment visual field

Symptoms include a sudden or gradual increase in spider webs or floating spots in the field of vision or flashing light in the eye. Another symptom is the appearance of a curtain in the field of vision.

Other symptoms include:

  • Seeing flashes of light in one part of the visual field
  • Sensation of heaviness in the eyeball
  • Seeing black dots, midges
  • The appearance in the visual field of floating objects (photopsy)
  • Distortion of objects, visual disturbance consisting in the deformation of objects, due to errors of perception in their correct placement in space. (metamorphopsia)
  • Decreased visual acuity (blurred vision)
  • Progressive reduction of side (peripheral) vision

All these symptoms must be an alarm signal for the patient, and he should present himself URGENTLY to a specialized ophthalmological consultation.

Retinal detachment diagnosis involves:

Dilation of the pupil and examination of the fundus with the biomicroscope, the ophthalmoscope, a procedure that aims to highlight the number and location of tears.
Posterior pole ultrasound - essential especially when the media of the eye is not transparent (eg. Cataract hypermature, co-existing corneal leukoma, retinal detachment with onset of sudden decrease in vision, major haemorrhage).

Although cataract is not directly related to retinal detachment, people with retinopathies such as retinal detachment may have an increased risk of developing cataracts. Cataract surgery may be necessary to prevent vision deterioration and help prevent serious complications. Patients are also advised to talk to their doctor about cataract symptoms and follow the indicated treatment to prevent any complications.

Retinal detachment treatment:

Vitrectomy

Vitrectomy is a surgical intervention that consists in the evacuation of the vitreous fluid (the transparent gel that fills the eye cavity, behind the lens), the reattachment of the detached retina, the laser treatment, and finally using tamponade with liquid, gas or silicone oil.

Pneumatic retinopexy.

During penummatic retinopexy a gas bubble is injected into the eye to help reattach the retina and prevent fluid from entering through the retinal tear. The laser is then used to permanently seal the tear or retinal detachment.

Local obturation in the area where the retinal detachment was located, this is performed in cases when the retina has partially detached;

vitrectomyCircular obturation is used in more serious cases, when the retina has completely detached;

Laser photocoagulation

Laser photocoagulation is performed to delineate the region of the tear and thinned segments of the retina.

If the retina is detached and is not operated on in time, fibrous changes occur in the vitreous, which in turn favor retinal detachment. Due to the traction process it exerts on the needlessteia, from a retinal tear with a partial/localized detachment to a total detachment. That's why retinal detachment is an ophthalmological emergency! This kind of operations are often accompanied by laser treatments/applications on the retina or the injection of special substances or gases inside the eye that also help to reattach the retina to the scleral wall. There are cases in which it is necessary to inject silicone oil, which has the role of keeping the retina glued more firmly to the eye wall, and this oil will then be extracted after a period of time.

 

Conclusion

vitreotome vitrectomy retinal detachmentIf not treated promptly, retinal detachment can lead to permanent vision loss.

Thanks to modern therapies, more than 90% of retinal detachment cases can be successfully treated, even when multiple reoperations are required. The best results are obtained in patients who are operated on before the macula is affected.

That is why it is very important to contact a retina specialist for a ophthalmological consultation  as soon as you notice one or more of the symptoms characteristic of retinal detachment shown above.