Q: Description of retinal detachment?
A: Retinal detachment is caused by a combination of factors including retinal holes, retinal breaks or retinal tears, liquefaction of the vitreous humor, and mechanical forces on the retina, often referred to as "traction".
A variety of factors can cause retinal holes, retinal breaks or retinal tears including:
Q: Symptoms of Retinal Detachment.
A: A suddden decrease invasion, sometimes described as a "shade or curtain" coming down over your vision.
Q: What is the relationship between near-sightedness and retinal detachment?
A: Simply having a longer eye associated with myopia probably does not cause retinal detachment, tears, holes, or breaks. A variety of peripheral retinal degenerations such as lattice degeneration are often genetically linked to myopia and may cause retinal holes, breaks, or tears.
Q: If a retinal detachment occurs after eye surgery, does it mean that the surgeon made a mistake?
A: No. Retinal holes, breaks, or tears can occur after uncomplicated eye surgery performed at the highest level of excellence. This complication is probably related to normal alterations in the vitreous humor (jelly) that often occur during or after eye surgery.
Q: What kind of trauma can lead to retinal detachment?
A: Direct trauma to the eye can lead to retinal breaks, holes, or tears that occur days, weeks, months, or even years after the incident. Trauma severe enough to cause a black eye, hemorrhage on the white part of the eye, hemorrhage within the eye, a penetration or laceration of the eye, cataract, light flashes, floaters, or decreased vision can be related to subsequent retinal detachment.
Q: What injuries typically cause retinal detachments?
A: Bottle rockets, BB guns, and paint balls lead to injuries often causing retinal detachment and should be outlawed or controlled. Bottle, fist, or elbow injuries associated with child abuse, abuse of women, or fighting can lead to retinal detachment. It is our hope that society will recognize the epidemic of child and partner abuse and take action. Racquetball, tennis, golf, soccer, boxing, and diving injuries can lead to retinal detachment. Patients and their lawyers often ask if falling down, automobile accidents, or being struck in the head without direct eye injury can lead to retinal detachment. While this may be possible, the relationship cannot be proven and is highly improbable.
Q: What can cause pulling on the retina?
A: A variety of conditions can cause it, including:
Q: I thought that only retinal breaks, tears, or holes cause retinal detachment. Not true?
A: Actually another form of retinal detachment called traction retinal detachment can occur as a complication of diabetic retinopathy, retinopathy of prematurity, inflammatory disorders, or trauma. The more common type of detachment associated with retinal holes, breaks, or tears is called rhegmatogenous.
Q: Can retinal detachment cause total blindness?
A: Yes, even a slight blockage of the vision caused by partial retinal detachment can result in blindness if not treated expeditiously.
Q: How common is retinal detachment?
A: Relatively uncommon. About 6-8 people out 10,000 experience retinal detachment.
Q: Are eye strain, nutrition, general health, smoking, or emotional stress related to retinal detachment?
A: No. There is no known relationship between retinal detachment and any of these problems.
Q: If one eye develops retinal detachment will the other develop it as well?
A: Detachment is more likely to occur if the other eye has the condition (such as lattice degeneration) associated with retinal detachment in the first eye. If only one eye suffers a serious injury or requires eye surgery then, of course, the chance of detachment in the other eye is not increased by the event.
Q: What treatments are used for retinal detachment repair?
A: Vitrectomy (removal of the vitreous humor), scleral buckles, gas bubbles, silicone oil, lasers, cryo (freezing), temporary balloons, and diathermy (thermal energy created by radio waves) can all be used to repair retinal detachments. These treatments are often used in combination. Typical combinations are:
Q: What is a vitrectomy and why is it used for the treatment of retinal detachment?
A: Vitrectomy means to remove the vitreous humor. Although vitreous humor is often referred to as vitreous jelly, the collagen fibers in the hyaluronic acid gel (jelly) are the component that causes retinal detachment. Vitreous pulls on the retina creating retinal tears or breaks. The vitreous never regenerates if it is removed, and the eye will have perfect vision and a normal shape without the vitreous. Patients often are concerned that the eye will collapse if the vitreous is removed or wonder what is used to replace it. Aqueous humor fills the former vitreous space within hours after surgery replacing the artificial aqueous humor (saline with additives called balanced salt solution) that is used to maintain eye pressure during and immediately after surgery. Vitreous removal reduces pulling (traction) on the retina, improves the surgeon's view, and provides space for a gas or silicone oil bubble.
Q: Are other techniques used during vitrectomy procedures?
A: Yes, scar tissue referred to as epiretinal membranes can be removed from the retinal surface using various methods of membrane peeling. Scar tissue can be removed from underneath the retina (subretinal surgery). A portion of the retina can be intentionally resected (cut) if it is contracted too much to become reattached. This is called retinectomy. Laser or cryo (freezing) treatment is usually used to make an intentional scar to seal retinal holes, breaks, and tears. This effect takes 7-10 days to be effective in preventing fluid from flowing through the retinal defect. Most laser or cryo applications are in the non-seeing far peripheral retina and do not cause significant loss of peripheral vision.
Q: What is a scleral buckle?
A: Scleral buckles are permanent components usually made of silicone rubber or silicone sponge material which are sutured to the outside surface of the back half of the eye in order to create a permanent indentation. Sometimes the components are shaped like an arc and are placed < to > of the way around the eye. In other situations the buckle is placed all the way around the eye (encircling buckle). The indentation acts inside of the eye much as a gasket is used to seal a radiator or the cylinder head of an automobile engine. In other words, the retinal pigment epithelium, choroid, and sclera, which are the three layers of tissue under the retina, are pushed inward against the retina. The buckling effect is placed adjacent to the retinal breaks, holes, and tears to help seal or support them. A secondary purpose of scleral buckles is to reduce pulling on the retina due to contraction of the collagen fibers in the vitreous humor. This works by pushing the retina inward.
Q: What is the purpose of the gas bubble?
A: Gas (and silicone oil) bubbles act via their surface tension to prevent the aqueous humor or saline solution from flowing through defects in the retina increasing the detachment. In other words, gas or oil is used to restore the pressure difference that is normally present across the retina. Either a gas or silicone oil bubble must be used if the vitreous is removed to repair retinal detachment because aqueous humor or saline solution readily flows through retinal defects. A gas bubble will be replaced by aqueous humor over a period of one to three weeks or more as the bubble absorbs. Gas bubbles (and silicone oil) float in the eye fluids and therefore migrate to the highest part of the eye. If the patient lies on his back, the gas bubble will come to the front of the eye, and will cause a cataract if the human lens is present. If the bubble is not on the trouble, it will not be effective in repairing the retinal detachment. If the patient lies with his right side down, the bubble will move to the left side of the treated eye, and vice versa. A patient can be seated with head bowed as if in prayer if the retinal defect(s) are on the upper part of the retina (or he has a macular hole). He must be face down in the bed with the head turned slightly left or right if the side or lower part of the retina is affected by tears, holes, or breaks. This is similar to the back rub position.
A patient cannot fly or travel via train, bus, or car to higher altitudes if there is a bubble in the eye unless the bubble is very, very small. If this rule is broken, the bubble will expand, causing severe pain and potentially permanent loss of vision.
Patients often ask, "Can I drive with a gas bubble in my eye?" If the other eye is perfect, it is legal to drive. Glare and obstructed vision from the bubble may make driving more difficult for certain individuals. Most of the prescribed positions after surgery are not compatible with driving. If a patient has a perfect non-operated eye and must drive in an emergency situation it is probably permissible for a short period of time.
Q: Are gas bubbles ever used without vitrectomy?
A: Sometimes gas bubbles are injected in the office to repair the retinal detachment without going to the operating room. This technique is called pneumatic retinopexy and is used for less complicated retinal detachments. This technique is usually used for detachments on the upper part of the eye because bubbles float to the top. The eye is anesthetized with drops or an injection and sterilized with a special disinfectant. A small bubble is injected and then fluid is removed from the front of the eye to equalize the pressure in the eye. Often the vision dims out for a few seconds until this fluid removal step is completed, normalizing the eye pressure. Sometimes cryo (freezing) is used before the gas bubble is injected but more often laser is applied to the retinal hole, break, or tear after the gas bubble reattaches the retina.
Q: Is there a laser only treatment for retinal detachment?
A: Yes, small retinal detachments can be treated by walling them off with laser treatment.
Q: Is there a medication or eye drop for the treatment for retinal detachment or is surgery the only option?
A: No. There is no medicine, eye drop, vitamin, herb, or diet that is beneficial to patients with retinal detachment.
Q: Do retinal detachments ever disappear without surgery?
A: Only if the detachment is due to a successfully treated medical condition such as toxemia of pregnancy or rare forms of eye inflammation.
Q: How long does the surgery take?
A: Surgical procedures usually take our doctors less than one hour. Gas injection alone takes ten to twenty minutes.
Q: Is the surgery performed on an inpatient or outpatient basis?
A: The surgery is performed on an outpatient basis in all cases unless there is a medical reason to stay overnight in the hospital.
Q: What is the success rate?
A: The surgical success rate for retinal detachment depends greatly on the type of retinal detachment and repair method but is typically between 70% and 90%.
Q: Are there any complications?
A: There can be: there is a significant incidence of cataract progression after vitreous surgery. Some doctors believe that patients with an absolutely clear lens develop cataracts as a result of vitreous surgery, but our doctors are skeptical. Many of the patients requiring vitreous surgery for retinal detachment already have nuclear sclerotic cataracts (yellowing of the center of the lens), which often worsen after vitreous surgery. Surgeons differ widely on the percentage of patients that suffer cataract progression due to vitreous surgery. Our doctors believe that the progression rate is about 10%; others believe that it is 100%.
Retinal detachment can occur after vitreous surgery performed for any reason, including repair of retinal detachment. Sometimes this is due to the method used but more often it is due to increasing traction on the retina from further contraction of the vitreous.
Proliferative vitreoretinopathy (PVR) is the most common cause of failure of retinal detachment surgery and often requires vitrectomy and silicone oil. Epimacular membranes (EMM)occur after about 2.5% of otherwise successful retinal detachment procedures.
Pressure elevation (glaucoma) can occur after all forms of eye surgery including surgery for retinal detachment.
Infection is very rare after retinal detachment surgery (about 0.02%).
Q: What care is required after surgery?
A: Precautions regarding gas bubbles and silicone oil are noted above.
In general, the retina becomes adherent to the undelying tissue, "sealing" the retinal holes/breaks/tears in 7-10 days. Normal activity can be resumed after the retina has been completely attached for two-three weeks. Older practices prohibited many activities such a bending over, lifting, etc.; avoiding these activities is no longer necessary. An eye patch is no longer needed after the first post-operative day.
Antibiotic drops are usually used for five to seven days, dilating drops for one to three weeks, and steroid drops for two to three weeks. Steroid drops are not used if it is thought the patient is genetically susceptible to steroid glaucoma. If the patient notices any new shadow or blockage of vision after the gas bubble is gone, it should be reported to the doctor.
Reattaching retinas often produce light flashes and floaters similar to those noted when detachment began.
Vitrectomy, laser, gas bubbles and silicone oil produce little if any pain. Antibiotics injected at the end of surgery are usually responsible for post-operative pain. Increased pressure can result from gas bubbles and occasionally silicone oil and other surgical techniques. Pain should be reported to the doctor. Scleral buckling surgery can produce moderate pain but most pain is from the antibiotics.