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RETINAL DETACHMENT

The function of the retina is to transform into nerve impulses the images that impinge on it and send them to the brain through the optic nerve. This thin layer of nerve tissue covers the entire interior of the eyeball and is attached to another tissue, known as pigment epithelium. Retinal detachment occurs precisely when the retina, even if only in a small area of all its extension, is separated from the tissue that serves as a support, which causes the affected area to stop working and to even break. If the problem is not treated quickly, the damage suffered by the retina can be irreversible and even cause blindness.

CAUSES

The factors causing retinal detachment are very different. There is usually a personal or family predisposition to having a  weak retina. Another possible cause that facilitates the appearance of retinal detachment is severe myopia.

In healthy people, however, it can happen as a result of a direct trauma experienced by the eyeball.

But it is also possible that there is a complication of other  eye diseases in which there is inflammation and internal bleeding.

Other types of detachments are those caused by diabetes. One of the most severe complications of advanced diabetic retinopathy is retinal detachment by traction. They are very complex cases to resolve through surgery and imply severe visual limitation.

SYMPTOMS

Retinal detachment does not cause pain. Its symptoms are always visual. The first noticeable symptom is usually the sudden and intense appearance of what are called  floating bodies or flies, which in this case are presented as dark spots that change position when moving the eye. However, the symptoms that should be a clear warning and lead to urgent consultation with the ophthalmologist are the following:

  • Seeing bright flashes.
  • An area of the visual field is covered by a kind of translucent curtain or drop of water.
  • If a distortion of the images or a severe visual diminution is noticed, it can mean that the affected area has been the macula, that is to say the central part of the retina located in the bottom of the eye.
  • With these symptoms, there can be an appreciable loss of visual acuity.

TREATMENT

Recognizing the symptoms and reacting immediately by going to an emergency department to consult a specialist is essential, since the retinal detachment can cause irreparable damage if not treated in its initial stages. Retinal detachment is a complaint given priority attention in ophthalmology and its treatment should not be delayed.

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SURGERY

The options currently available for the treatment of retinal detachmentare different and it may be necessary to combine several of them:

  • Laser photocoagulation. The tears produced in the retina are isolated by cauterizing the affected area with a laser, which is done through the pupil on an outpatient basis.
  • Cryotherapy. It is also done through the pupil and the cold is used to cauterize the rupture of the retina.
  • Pneumatic Retinopexy. It consists of applying a section of detached retina by the inclusion of a gas bubble inside the eye. Then laser or cold is usually applied. The gas applies pressure and replaces the detached retina. This gas will reabsorb itself.
  • Scleral surgery. Retinal rupture repair is performed by applying external pressure to the eyeball by placing a silicone band (explant) around the sclera, which is the outermost layer of the eye. In this way, we approximate the wall of the eyeball to the detached retina. This technique is usually combined with a transcleral drainage, by puncture, of the subretinal fluid. It also requires a laser or cold association to seal the tears that caused retinal detachment.
  • Vitrectomy. It consists of emptying the vitreous of the interior from the eyeball, releasing internal fractions and giving elasticity to the detached retina. The retinal detachment fluid is then drained with a heavy oil and the vitreous is replaced with silicone oil gas which will keep the retina in contact with the wall of the eyeball. This technique also requires the application of laser or cold on the tears. It can be combined with scleral surgery.