Retinal Detachment

What is retinal detachment and how it happens?
A retinal detachment is occurs when the retina separates from the back wall of the eye. This typically happens when liquefied vitreous fluid (fluid inside the eye) passes through a small tear in the retina and collects behind the retina. This collection of fluid causes a lifting action and markedly disturbs the vision. Frequently, detachments begin with loss of peripheral vision and patients may notice a dark shadow, or a veil, coming from one side, above or below. Left untreated, in most cases, after a retinal detachment starts, the entire retina will eventually detach and all useful vision in that eye will be lost.

This is a serious eye disease and may lead to total blindness if not treated adequately in time.
 
Who gets retinal detachments?
Some people are at increased risk of developing retinal detachments. The high risk group includes those with a high degree of nearsightedness, a family history of retinal detachment, or those who have previously experienced a retinal detachment. Patients that have had cataract surgery also experience about a 1-2 % chance of developing a retinal detachment.
 
What is the treatment?
The treatment is a surgery in most of the cases. The surgery can be either a retinal surgery or a vitreous surgery depending on the severity and duration of the detachment.

Retinal Surgery
This involves scleral buckling -where a sponge or length of silicon plastic is placed on the outside of the eye and sewn inplace (the scleral buckle is very small and not visible after surgery), pushing the scleratoward the tear in the retina and allowing it to seal.

Vitreous Surgery
If the retinal detachment is too severe for scleral buckling, vitreous surgery to reattach the retina may be necessary. Here, the surgeon removes the vitreous entirely, replacing it with a gas or silicon oil. Membranes if any are also removed. A scleral buckle, if required, can be additionally used. Overtime, the gas is absorbed, and replace with the eye's own fluid. Lack of vitreous does not affect the patient's vision. Silicon oil if used needs to be removed later when surgeon thinks its safe enough to remove.
 
What are the chances of success? How much vision will I regain?
The success of these surgical techniques depends upon several factors including the sizeand location of the damaged area of the retina, the length of time that elapses between theonset of the tear or detachment and the surgery to repair the damage, and whether or notother complicating factors are present. Many persons who have undergone retinalreattachment surgery regain all of their previous vision, while some regain only functionalvision. Even in these latter instances, the treatment is usually effective in preventing furtherdamage to the retina and more vision loss.
 
How long can I wait for the surgery?
This surgery is an emergency procedure and should be performed as soon as possible.The chances of successfully restoring vision are dramatically improved when intervention occurs as soon as possible following the onset of symptoms.With each passing day of untreated detachment, retina further looses its ability to function.
 
How is the surgery done?
The surgery can be done either under a local or a general anesthesia depending on the surgeon and patient preference. All of these surgical techniques are done microscopically. We want to reassure you that your surgeon does not take your eye out of its socket to operate on it. This is simply impossible.
 
How long will it take?
The surgery itself takes around 1½ to 3 hours to complete depending on the conditions and complicating factors inside eye.
 
When would I see after surgery?
It usually takes 1 to 2 months for visual recovery. The vision recovery may continue till 1 year, at the end of which no further improvement is possible.
 
What are possible complications?
As with any surgery, complications can happen both during surgery and after surgery. It includes intraocular hemorrhage, muscle damage, ocular perforation and rarely infection inside eye. If silicon oil is used in repair; it may cause cataract, glaucoma or damage to cornea.
 
Will this recur again?/ Will I need another surgery?
The surgery is usually successful in attaching retina in 80-85% cases. Remaining 10-15% patients may require a second surgery. However, this depends on many factors. You can ask your doctor regarding this in your individual case.
 
Is there any treatment without surgery?
Very small detachments of the retina can be surrounded by laser treatment, just like retinal tears, to help limit their spread. Another procedure called Pneumatic Retinopexy, which is less traumatic than surgery, can be done for selected cases. Here, the surgeon injects a gas bubble inside the vitreous cavity. The bubble pushes the retina against the wall of the eye, allowing the tear to seal against the eye wall. However, this type of treatment can be done only in some selected patients only and requires patient to be seated or lie in a specified position for 12-18 hours in a day. Failure to maintain position will result in failure of treatment. If this treatment fails to reattach the retina, a second surgery in form of scleral buckling or vitrectomy will be necessary.
 
Can this be cured with glasses or with lens inside eye?
This can not be cured with glasses or medicines. Putting lens inside eye is treatment for cataract and will not attach retina which is the cause of loss of vision in your case. However, if a cataract is present simultaneously, IOL can be put alongwith or after surgery for retinal detachment depending on stage of cataract.
 
What will happen if I don’t treat?
The detachment of the retina from the back wall of the eye causes it to be removed from its blood supply and therefore its source of nutrition. An untreated detachment will cause the retina to degenerate and lose its ability to function, permanently in some cases. After a few years, it will totally lose its ability and surgery will not be effective at that stage.
 
Will this affect my other eye?
This will not affect the other eye. However the other eye is at a higher risk of detachment than normal. The other eye should be examined and treatment in form of laser or freezing (cryo) should be done if necessary.
 
Why should I get the surgery done if I am not going to get full normal vision back?
This is a serious eye disease and may result in total blindness. There is no other treatment. Even though you may not see as well as you were before detachment, surgery will most probably improve vision from its current level. Even if you don’t get 100% recovery of function, the treatment is usually effective in preventing further damage to the retina and more vision loss, failing which you may lose all your vision.
 
Retinal Detachment with PVR
 
What is PVR?
PVR is proliferative vitreo-retinopathy; a term used to describe the formation of membranes over or behind detached retina and in vitreous cavity. These membranes, which are essentially scar tissues, exert traction on the retina and may result in recurrences of retinal detachment, even after an initially successful retinal detachment procedure. PVR may be associated with spontaneous reopening of otherwise successfully treated retinal breaks and may even cause the development of new retinal breaks. Finally, PVR may be associated with severe distortion and "stiffness" of the retina, as a result of the contracting membranes. This aspect of the condition not infrequently results in disappointing visual results, despite the very best of management.
 
What is treatment of PVR retinal detachment?
Treatment is essentially surgical and requires vitrectomy along with placement of silicon ring around the eye called encirclage. During vitrectomy, the vitreous humor is removed and the vitreo-retinal surgeon then performs a membrane peeling procedure, in which the contracting membranes on the retinal surface are carefully peeled away from the retinal surface. The surgeon will also typically treat the retina surrounding any retinal tears or holes with laser to help maintain closure of the retinal breaks.

Following the vitrectomy procedure, the surgeon usually instills special gases or silicon oil into the eye to help flatten the retina and keep it reattached to the outer wall of the eye. If gases are instilled in the eye, head positioning following surgery (for days or weeks) may be necessary to help keep the retina attached. If silicone oil is placed in the eye to help maintain the retina in the attached position, it must eventually be removed from the eye in the majority of cases after 3-6 months depending on status of retina.
 
What to expect after surgery for PVR?
It is important to realize that recovery of vision after surgery for PVR may take many months. About 50% of patients will regain some useful vision in the affected eye. The level of vision regained, however, is often referred to as "ambulatory vision," indicating vision good enough to see large objects at a close range. The likelihood of regaining vision well enough to read is quite low.