A Family Doctor's Tale - RETINAL DETACHMENT

DOC I HAVE RETINAL DETACHMENT

Retinal detachment can be a very difficult condition to diagnose and treat.

In severe cases the risk of blindness is very high.

Treatment with Vitrectomy which involves the removal of the vitreous gel followed by filling the eye with a gas bubble is painful and need a long period to recover.


Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.

Retinal detachment is a medical emergency.



The following are at risk from Retinal detachment:

1. age above 55 yrs

4. very short sighted (myopia usually above 5-6 diopters)

3. history of serious eye injury (injury to orbits)

4. history of eye cataract surgery

5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)

6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition



There are 2 types of retinal detachment:

Primary:

There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.

The holes are usually at the periphery.

It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.

Secondary:


Other eye diseases which can separate the 2 layers are:

1.Choroiditis-

inflammation of the choroid cause exudation of serous fluid under the retina layer

2.Toxemic retinopathy -

inflammation of the retina cause exudation of serous fluid under the retina layer

3.proliferative diabetic retinopathy -

abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye

4.vitreous hemorrhage after injury to the orbits -

blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.

5.Choroidal melanoma(a malignant tumor) -

a growth below the layers of the retina can push the layer of retina from the back of the eye

Symptoms:

1.transient flashes of light

2.a sudden increase of floaters in one eye

3.a ring of floaters at the temporal region of the central vision

4.a feeling of heaviness in the eye

5.the presence of cloud in front of the eye so that parts of an object are not seen

6.the sensation of a curtain falling over the central vision of eye

7.Straight lines that become curved

8.Central vision intact at first followed by complete and total loss of vision if untreated

Signs:

1. In early stage, direct opthalmoscopy show very little abnormality

2. Indirect opthalmoscopy may show the presence of the detachment.

3. The pale white or grey folds of the detachment can be seen

Diagnosis of retinal detachment is by:

1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.

2.Transillumination and ultrasound may be useful to detect neoplasm

3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.

Complications of Retinal detachment are:


Partial to complete loss of vision.



Retinal detachment is a medical emergency.

The most important part of treatment is finding the holes or tears and closing them.

Primary:


1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.

2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.

3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.

4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sightedness after the operation.

5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..

6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.

After treatment the results are usually good and vision is regained over a period of a few weeks.

Secondary:


1.Neoplasm: surgical removal of neoplasm

2.Traction detachment: vitreous surgery, prognosis is poor

3.Others:Fluids usually resorbs as underlying condition is treated.

Retinal detachment must be continuously monitored

1.regular follow up with the eye doctor.

2.examining the retina for further damage

3.analyzing the visual fields.

With proper monitoring and treatment most patients will be less likely to be at risk of blindness.



The prognosis varies depending on the the underlying disease.

Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.



Retinal detachment can be prevented by:

1.educating people of the symptoms suggestive of a posterior vitreous detachment.

2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.

3.Avoid known risk factors for retinal detachment.
a.Cataract surgery

b.Trauma (boxing, kickboxing, karate, etc.)

c.high level of myopia


d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping