Explanation - The retina becomes detached when it becomes anatomically displaced from the inside of the eye. Normally, the retina lines the inside of the eye, much the way wallpaper lines the inside of a room. There are two types of retinal detachment; rhegmatogenous retinal detachments and traction retinal detachments.

Rhegmatogenous retinal detachments are the more usual form of retinal detachment and commonly occur in healthy eyes. In this type of retinal detachment, a hole or tear forms in the retina, allowing fluid from the center of the eye to migrate to the potential space underneath the retina. Symptoms of a retinal detachment include acute onset of floaters, flashes or loss of peripheral field.

Management - A retinal detachment is potentially blinding and efforts are made surgically to reattach the retina to prevent total blindness. There are several procedures which may be used to repair a retinal detachment. Operating on the outside of the eye, a scleral buckle is placed around all or a portion of the eye. The scleral buckle acts to reduce the internal diameter of the eye which also reduces internal traction on the retina. A vitrectomy may also be employed, operating on the inside of the eye, to remove the vitreous and also relieve forces pulling on the retina. Either may be used alone or in combination with the other. In any case, intraocular gas may be placed in the eye. The gas acts as a “cork” to block migration of fluid from the center to the subretinal space. Depending upon the location of the hole or tear, the patient may be required to maintain a specific head position after the operation.

Risks - Major risks of surgery are the same as all intraocular procedures. There is the potential risk of blindness from infection although the rate is less than that of cataract surgery. Recurrent retinal detachment is possible and reoperations are not uncommon. Progression of cataract may be noted, increase in myopia and double vision are also possible, but these complications are less serious.

Goals of Surgery - The goal of retinal detachment surgery is to repair the detachment to prevent blindness. Location and size of a retinal detachment are factors that may influence the timeliness of surgery. Visual prognosis is best if the macula (functional center of the retina providing central vision) is unaffected at the time of surgery.

Written by Randall V. Wong, M.D., retina specialist/ophthalmologist, Fairfax, Virginia.

www.VirginiaOphthalmologist.com

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