RETINAL DETACHMENT What is Detached Retina? The choroid is a system of blood vessels, located between the retina and sclera, which provides nourishment to the retina. When a portion of the retina becomes separated from the choroid this detached part loses its nourishment and results in a temporary decrease in vision. The vitreous is a clear gel in the eye which is attached to retina. Vitreous sometimes gets separated from retina which is mostly uneventful, but occasionally the retina is pulled with it causing retinal detachment. Sometimes fluid from the vitreous body passes through the retinal tear and detaches the retina from the choroid .As the retina is lifted away vision becomes darkened and distorted. If the detachment is small and in retinal periphery it may remain asymptomatic while involvement of macula may lead to total blindness. Warning symptoms: Vitreous pull may appear as flashes of light. Floaters. A gray curtain moving across the field of vision. All cases with these symptoms may not develop a retinal detachment. However it needs thorough eye examination by your ophthalmologist. Who are at risk? It can occur in 1 out of 10000 persons but chances are more in Myopes Persons with family history of Retinal detachment Retinal detachment in other eye Post cataract surgery Injury to eye. How is detached retina treated ? If the fluid can be prevented from passing through the hole or tear in the retina and the already accumulated fluid beneath the retina can be drawn off, the retina will return to its normal position. There are several ways of accomplishing this by surgery, but closing the retinal holes is the common aim of all techniques. Treatment starts with the careful drawing made of the retina. More than one retinal hole is often found, and each one must be treated for a successful result. Surgical techniques vary according to the case. Every operation produces a scar in the retina and choroid by cryotherapy, diathermy (heat) or laser. The scarring process seals off the hole in the retina in almost the same way as a patch is vulcanized over a leak in an automobile tire. Methods of Surgery: 1. Scleral Buckling: It is the traditional way of operating retinal detachment. In this a plastic ( Silicone ) material may be attached to the outside wall of the eye (explant) or in dissected scleral flap ( implant) in such a way as to indent it, creating an internal hump, the scleral buckling. This holds the scarred area of the choroid against the detached retina, while the bond around the hole is hardening, The fluid beneath the retina may or may not be drained out by a cut through sclera.Ideally, the treated choroid and retina will lie so that the hole is on the buckle. The plastic band is left in the eye and is not visible and does not cause problem. 2. Pneumatic retinopexy: It is less traumatic and faster surgery than scleral buckling . However it can be done in selected cases only. It can only be done in cases with single or multiple break located within one clock hour in the superior two-thirds of the fundus. In this after doing cryo to retinal break a gas is injected in vitreous which pushes the retina to choroid till the break seals. In this the patient has to maintain a posture as advised till complete healing occurs. Results of Surgery Results of surgery are unpredictable and there may be about 10% cases requiring second surgery. Visual outcome depends on the damage to retina already done and is not known. If retinal detachment is not operated it will lead to progressive loss of vision. Vitrectomy for Retinal Detachment Occasionally a retinal detachment cannot be settled by scleral buckling specially in detachments with: Vitreous opacities as haemorrhage. Proliferative Vitreoretinopathy (In this case there is excessive scar tissue growth on the retina). Giant retinal tears ( tear involves more than a quarter of retina). Trauma and Intraocular foreign body. Posterior retinal break Macular hole and optic pits. Choroidal coloboma In these cases vitreous is removed along with scar tissue relieving traction on the retina and space is filled by fluid, air or silicone oil to hold the retina back till the break gets sealed by laser or cryotherapy. The air and fluid gets replaced by body own fluid but silicone oil needs removal later on. The lack of vitreous does not affects the functioning of the eye.
Posted on: Tue, 08 Jul 2014 15:42:09 +0000
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