What is a retinal detachment?

A retinal detachment is a serious condition in which the retina separates from the wall of the eye. The retina is the lining of the back of the eye responsible for vision.  If not treated, retinal detachments may lead to permanent loss of vision

What causes a retinal detachment?

The eye is filled with a jelly called ‘vitreous’ which is in contact with the retina.  With age, the jelly shrinks and pulls on the retina. If the jelly pulls too hard, a hole forms in the retina, allowing fluid to passes underneath the retina and separate it from the wall of the eye.

The risk factors for a retinal detachment include short-sightedness, trauma and eye surgery but mostly it is due to the aging process of the vitreous.

What are the symptoms of a retinal detachment?

Initially, there may no symptoms, but often the first symptoms consist of flashes, floaters or a shadow which blocks part of your peripheral vision.  Further progression will lead to central vision and loss of total vision.

What is the treatment for a retinal detachment?

Surgery is needed to reattach the retina. The type of operation depends on the features of the retinal detachment and is usually performed using local anaesthesia.

The options include:

1. Pneumatic retinopexy

A gas bubble is injected into the eye.  It stops fluid from passing through the hole, allowing the retina to reattach. You must keep your head in a particular position for 5 days afterwards (for 50 minutes out of every hour) to position the bubble in the correct position.  Laser or freezing treatment is performed between 1 to 3 days after the gas injection to seal the retinal tear.

2. Scleral buckling surgery

A piece of plastic (known as a buckle) is attached to the eye wall (known as the sclera). The buckle creates an indentation in the eye wall which closes the hole inside.  Freezing treatment is used to seal the retinal hole.

3. Vitrectomy surgery

The vitreous is removed using keyhole surgery through tiny openings in the eye wall.  A bubble of gas or silicone oil is placed in the eye to seal any holes in the retina while it heals. Laser or freezing treatment is used to seal the retinal holes. Vitrectomy surgery is used for both routine and complex retinal detachments.

Silicone oil is used when the retina needs support for longer than one week and allows some moderate vision. This silicone oil may remain in the eye long term, or it can be removed after the retina has proven that it is sufficiently adhered to allow remova, which provides further improvement in vision.  A gas bubble is used for shorter term retinal support but the patient will not be able to see through the gas bubble until it dissolves.  The patient will not be able to go up in altitude, ie. no air flights are allowed whilst the air bubble remains in the eye (this is temporary and may last for a number of weeks).

Occasionally, a combination of the 3 surgical techniques described above is needed.  In essence, the retina behaves differently in different patients depending on the number of tears, the position of tears and the stage or progression of the retinal detachment. Your surgeon will employ whatever technique is required to successfully re-attach your retina and give you the highest chance of continued retinal attachment following the initial surgery.  The degree of visual improvement from surgery depends upon the behavior of the retina and macula before surgery and after surgery.  A retinal detachment will unleash a variety of biological processes which will continue after the initial successful re-attachment of the retina. The processes can significantly effect the vision post-operatively and include further scarring of the peripheral retina and detachment from processes such as proliferative vitreoretinopathy (PVR),  and  scarring of the central macular (epiretinal membranes, macular pucker) , cystoid macular oedema and glaucoma.

The degree of visual improvement after surgery depends upon whether the retinal detachment has affected the macula.  The macula is the central part of the retina responsible for clear vision.  If the macula has not been affected, then full vision may be recovered.  However, if the macula has been affected, your vision will still recover, but not fully.