Retinal detachment

Content

Introduction

Introduction

The retina is a thin layer of nerve tissue, sensitive to light, which lines the inner surface of the eye and transforms light waves into nerve impulses which are then transported to the brain through the optic nerve fibers.

In detachment, the retina separates from the underlying vascular layer (choroid or uvea) from which it takes oxygen and nourishment and, as a consequence, its cells suffer and die (Video).

Depending on the size of the part that detaches, its position and the amount of time that has elapsed since its detachment, temporary or permanent eye damage can occur.

Symptoms

Symptoms

Symptoms caused by retinal detachment are visual disturbances:

  • fixed black spots
  • flying flies or floating dark bodies (floaters)
  • short flashes of light (photopsias)
  • blurring or distortion of vision
  • shade or a dark curtain covering part of the field of view (scotoma)

They generally affect only one eye (the probability of having a detachment of the retina at the same time as both eyes is a 1 in 10 chance).

Without treatment they tend to get worse and no longer reversible and can lead to vision loss.

Causes

Causes

In the detachment of the retina, tears are formed in the tissue of which it is formed which favor the passage of liquid under it, away from the underlying vessels. Some conditions that can promote detachment are:

  • rear detachment, partial, of the vitreous body with the consequent formation of vitreo-retinal traction points. It is a phenomenon normally associated with aging; detachment can occur when anchoring points remain on the retina, which exert traction
  • severe myopia
  • some eye surgeries, such as cataract removal
  • diabetic retinopathy
  • glaucoma
  • inflammation inside the eye (uveitis) or some rare eye cancers which lead to the accumulation of fluid under an intact retina

The detachment of the retina can also occur due to trauma, either direct, for example a punch, or indirect, as in the case of blows to the head or recoils (the classic one that can occur in a road collision).

Therapy

Therapy

The treatment (therapy) of retinal detachment is surgical and is based on the "elimination of the traction of the vitreous body on the retina and the closure of any laceration. In 85% of cases, a single operation is sufficient to reattach the retina.

There are various types of techniques that can be performed under local or general anesthesia; the specialist chooses the most appropriate one based on the specific case and the relative risk-benefit ratio. The techniques currently in use are:

  • vitrectomy, it consists in the removal of the vitreous body and in its replacement with a gas or with an artificial vitreous substitute which, by plugging the retina, restores contact with the underlying vascular layer. This surgery is generally performed by making three very small holes in the external wall, for the insertion of microsurgery instruments. At the end of the operation, the operated person will have to take a particular position for a few days in order to allow the gas bubble, or the artificial substitute, to remain in contact with the rupture for as long as possible. The gas will be gradually reabsorbed spontaneously while the artificial substitute will have to be removed surgically. It is not possible to drive or take a plane until the gas or substitute has been reabsorbed or removed. In the event that the operated person needs to undergo surgery of any kind, he must notify the doctor of the presence of the gas / substitute inside the eye
  • pneumoretinopexy, it is used in case of detachments of limited and uncomplicated dimensions. It consists of inserting a small gas bubble into the eye which pushes the retina into the correct position. It is accompanied by laser or cold treatments (cryotherapy) to repair tears and maintain retinal adhesion. As with vitrectomy, at the end of the operation the operated person will have to take a particular position for a few days in order to allow the gas bubble to remain in contact with the break for as long as possible. The restrictions on the behavior to be observed are the same
  • scleral cerclage, consists in the compression of the eyeball, through the external application of a silicone band in such a way that the external part of the ocular wall is found close to the detached retina and this, in turn, to the vitreous body, in order to release its traction . The break, no longer subjected to traction, can close again and laser or cold treatments will prevent it from reopening

The visual picture after treatment will depend on the size of the retinal detachment and its duration. The greater the duration of the detachment, the less is the possibility of visual recovery.

In cases where the detachment affects the area of ​​central vision (macular region) visual recovery will be incomplete.

Prevention

Prevention

To prevent retinal detachment, it is advisable to educate people who have predisposing conditions to quickly recognize the signs so that they can be ascertained as soon as possible (early diagnosis) and immediately proceed to treatment.

Complications

Complications

There is a low probability, during or after surgery, of developing complications. They may include:

  • bleeding inside the eye
  • formation of other tears in the retina
  • increased intraocular pressure (glaucoma)
  • opacification of the lens (cataract)
  • double vision (diplopia)
  • drug allergy
  • eye infection

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