Retinal Tear & Retinal Detachment
The retina is nerve tissue that acts like the film in the camera of the eye. It lines the back of the eye, like wallpaper on a wall, absorbs the light that enters the eye, and converts it into an electrical signal to send to the brain. The most common cause of retinal detachment is when a retinal tear forms due to the spontaneous separation of the vitreous gel (PVD), which allows fluid from inside the eye to get under the retina (the “wallpaper”) and separate the retina from the back of the eye. (See the section on flashes and floaters.) The common signs of a retinal detachment include floaters, flashes of light, and a shadow in the peripheral vision that gradually moves toward the central vision.
Types & Causes
There are 3 general types of retinal detachments: rhegmatogenous, tractional, and exudative.
Rhegmatogenous retinal detachments are by far the most frequent type of retinal detachment and are caused by holes or tears in the retina that allow fluid to collect underneath the retina, detaching it from the back of the eye. Retinal tears usually occur when the vitreous gel separates from the retina as part of the aging process (see the flashes and floaters section) or in individuals with thinning in the peripheral retina, known as lattice degeneration. In some cases, trauma can also cause retinal tears.
Tractional retinal detachments happen when scar tissue forms over the retina, pulling it away from the back of the eye. This type of retinal detachment most commonly occurs in the setting of diabetic retinopathy.
Exudative retinal detachments are the least common form of retinal detachment and occur without any break or tear in the retina. This type of retinal detachment is typically related to inflammation, tumors, or excessive leakage from abnormal blood vessels causing fluid to build up under the retina.
Risk Factors & Symptoms
Risk factors for developing a rhegmatogenous retinal detachment include:
- Lattice degeneration (thinning in the peripheral retina)
- High near-sightedness (myopia)
- Family history of retinal tears or retinal detachment
- Previous retinal detachment
- Previous eye surgery
- Trauma
Common symptoms of a retinal detachment include floaters, flashes of light, and a shadow or curtain in the peripheral vision that can worsen, potentially leading to central or total vision loss. Less commonly, patients may have a retinal detachment without any symptoms. The severity of the vision loss is often related to the extent and duration of the detachment.
Treatments
The goal of retinal detachment surgery is to reattach the retina to the back of the eye (essentially putting the wallpaper back on the wall) and seal the tears or holes that caused the detachment, preventing further fluid from collecting underneath the retina. There are several methods available for repairing a retinal detachment:
Scleral buckle: In this outpatient surgery, a silicone band is placed around the outside of the eye to help close the retinal tear and support the detached retina. This band goes under the muscles of the eye and behind the patient’s eyelids. You can’t feel the band or see it when you look at the eye, and it remains in place indefinitely. Sometimes a scleral buckle will be used alone to repair a detachment, and sometimes it will be used in combination with a vitrectomy.
Vitrectomy: This outpatient procedure involves making three small incisions in the white part of the eye. Fine instruments are then used to remove the vitreous gel inside the eye. Afterward, the fluid under the retina is drained, and a laser is used to seal any retinal tears or holes. The eye is then filled with a gas bubble or silicone oil to help hold the retina in place while it heals. Patients are often required to maintain a specific head position following the surgery to ensure the gas bubble presses against the torn, detached retina. This positioning is typically needed for about one week.
Pneumatic retinopexy: This office-based procedure involves injecting a gas bubble into the eye, and the patient must maintain a specific head position to align the bubble with the retinal tear. The tear is then sealed using either a freezing treatment during the procedure or a laser after the retina is reattached.
After treatment for a retinal tear or detachment, patients are usually advised to avoid strenuous activities for a few days. If a gas bubble is used in your surgery, you'll also need to avoid flying or going to high altitudes until the bubble dissolves. Your surgeon at Mid Atlantic Retina Specialists will provide detailed, individualized instructions before the procedure.
Success Rate & Prognosis
In general, the overall success rate of reattaching the retina with a single surgery is around 80-90%. The main reason the success rate is not 100% is that 10-20% of the time, scar tissue called proliferative vitreoretinopathy (PVR) can form on the retinal surface and pull the retina off the back of the eye. If this happens, the retina can usually be reattached, but it will require an additional surgery. If PVR is going to form, it typically occurs in the first 4 months following the initial retinal detachment. The main risk factors for PVR formation include: number and size of retinal breaks, high myopia (nearsightedness), trauma, vitreous hemorrhage, smoking, and young age, among others. There is no proven way to prevent PVR from forming, and your surgeon will monitor you carefully in the initial post-operative period to help detect the presence of PVR and treat it as soon as possible.
If the retina is re-attached successfully and stays attached without PVR formation, there is usually a significant improvement in vision following retinal detachment surgery. If your central vision was affected by the initial retinal detachment, it is unlikely you will regain all of your vision. It is common for patients to have some degree of permanent blurry and distorted vision following a retinal detachment, even in the best of cases. If severe scar tissue forms, the retina may not be able to be repaired, and the eye may never regain vision.
Schedule a Consultation for Retinal Tears & Detachment
At Mid Atlantic Retina Specialists, our team of experienced retina specialists can diagnose and treat a wide variety of retinal conditions, including retinal tears and detachment. Request an appointment today at one of our retina centers in Hagerstown, MD, Frederick, MD, Chambersburg, PA, or Bedford, PA.
