| How
Does the Retina Become Detached?  The
eye is like a tiny camera, with lenses in the front and
film in the back. The film is called the retina. It lines
the back three quarters of the eye like an inner tube. The
center of the eye is filled with a jelly-like material called
vitreous. It is thick during childhood, but later becomes
watery. In many cases, the back layer of the vitreous can
pull away from the retina, and in some cases, tear it. Fluid
can then leak through the tear and allow it to detach from
the back of the eye. This causes loss of vision because
the retina relies on the back wall of the eye for its nourishment.
What
Are the Symptoms of Retinal Detachment?
 When
the vitreous gel peels away from the back of the eye, the
normally clear fibrous strands clump together and cast shadows,
referred to as floaters. When the gel pulls or tears the
retina, this stimulates the retina and may cause flashing
lights to be seen. Flashes and floaters are the warning
signs of a possible impending retinal detachment. Flashes
and floaters do not always signify a retinal tear or detachment.
Prompt evaluation by an eye doctor may find a retinal tear
before it causes a retinal detachment. Laser surgery or
cryotherapy (localized freezing treatment) may prevent the
retina from detaching and save the patient from needing
to have a more serious operation.
A progressively enlarging dark curtain or shadow in one
eye often signifies a developing retinal detachment. The
curtain usually starts in the peripheral or side vision
and eventually may spread to the central vision. At this
point, laser treatment is not likely to be helpful and an
operation is usually necessary.
What
are the Treatments for Retinal Detachment?
There are several types of surgery
that can repair a detached retina. The surgery usually consists
of one or more of the following procedures:
Scleral Buckle
A plastic band is often placed around the eye to indent
and support the area of the tear. It may extend all the
way around the eye, like a belt, or it may be fixed to only
one area. The patient cannot see or feel the band once the
eye has healed. The scleral buckle is meant to stay in place
for your entire life.
Pneumatic Retinopexy
If the tear causing the retinal detachment is in the top
half of the eye, it may be possible to seal it with a gas
bubble injected into the eye. This is combined with special
head positioning to push the bubble against the tear, and
laser or freezing to “glue” the tear back into
position and prevent redetachment. This is a good treatment
option for only occasional retinal detachments. Your surgeon
will advise you on your individual case. If the bubble does
not work, scleral buckling and/or vitrectomy may be recommended.
Vitrectomy
In more complicated retinal detachments, vitrectomy surgery
may be necessary. This operation removes the vitreous jelly
as well as any scar tissue or blood, which may have accumulated.
The vitreous is replaced with special fluid or sometimes
a gas bubble. The fluid or gas is replaced by the eye’s
own fluid over time without any further surgery.
Before/During/After
the Operation
Before
the Operation
A general physical examination is part of the preoperative
routine. In some cases, other laboratory testing is necessary,
depending on your age and physical condition. We will consult
with your primary care physician to discuss your case and
secure clearance for your surgery. An anesthesiologist will
interview you and assist your doctor with preoperative medications.
The Operating Room
An intravenous line will be placed into an arm or hand vein.
If you are having general anesthesia, you will not be aware
of the operation. You will be in the recovery room when
you wake up. If you are having local anesthesia, a tranquilizer
will be injected in the intravenous line. You will be relaxed
and sleepy. You may or may not fall asleep. A local anesthetic
will be injected around, but not into your eye. You should
feel no pain.
After the Operation
Following surgery you will remain in the recovery room for
a short period under special supervision. You will have
a patch on your eye. Some pain is to be expected, which
is controllable by oral or injected medication. Some nausea
is not uncommon and will also be treated with medication.
If vomiting should occur after surgery, this will not harm
the eye. The intravenous line may be discontinued once you
are fully awake. Most retinal surgery can be done as an
outpatient, but rarely an overnight hospital stay is required.
Postoperative
Examination and Advice
You need to be examined the
day after surgery and usually again within a week. At this
time, you will be given an eye drop prescription, eye pads,
tape and instructions. The main purpose of the eye patch
is to soak up tears, and it may be removed once tearing
has subsided. You may wash your hair at home or have it
done at a hair salon. You should not allow running water
directly on the operated eye, so you may want to wear an
eye patch while showering and remove it when done. Most
people may resume their normal lifestyle as quickly as they
wish and return to work within one to two weeks following
surgery. Your eye may feel scratchy or sore, and you may
have a stuffy nose for a few days after surgery. You may
do whatever is comfortable, but should rest as needed. If
a gas bubble is placed in your eye during the surgical procedure,
you should not fly in an airplane or receive anesthetic
gases. Either can cause the bubble to expand, causing pain
and possible damage to the eye. Your doctor can determine
when it is safe to fly or have anesthetics. Your physician
will tell you if special positioning or activity limitations
are necessary.
Patients ultimately return to their referring doctor for
their continuing care. If you wear glasses or contact lenses,
the power of the lens may change as a result of your surgery.
We usually do not recommend changing your glasses or contact
lenses for about two months following surgery to allow the
new prescription to stabilize.
The
Outlook
If your vision was good before
surgery, the chances are excellent that you will maintain
normal or near normal vision following surgery. If the vision
was poor before surgery, especially if the detachment was
longstanding, the visual return may be slow and incomplete.
A single operation successfully re-attaches the retina in
more than 90 percent of cases. In a few cases, scar tissue
may begin to form inside the eye, which pulls on the retina
causing it to re-detach. If the retina should detach again,
it usually does so within several months of surgery and
can often be repaired with another operation. Great strides
have been made in retinal detachment surgery over the past
20 years. Retinal detachment, which was once an incurable
problem, can now be helped in the vast majority of cases.
Back
to the Retina Center
|
