What is it?
Retinal detachment
Retinal detachment occurs when the retina separates from the tissue to which it is attached (pigment epithelium) and which supports it, even if it is only a portion of its entire length. This separation can cause retinal tears or holes, through which the vitreous gel gradually seeps and can end up detaching the retina completely.
When this occurs, the affected area stops functioning properly and generates an abrupt loss of vision. In order to prevent the damage suffered from producing retinal atrophy, chronic ocular inflammation, or even causing severe visual limitation that is irreversible, this condition should be considered a medical emergency and should be treated immediately by an ophthalmologist.
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Some of the risk factors that can trigger retinal detachment are family/personal predisposition to have a weak retina, myopia (high prescriptions) and diabetes (complication associated with advanced diabetic retinopathy). However, in healthy people, it can also occur as a consequence of ocular trauma.
SYMPTOMS
Retinal detachment does not cause pain and its symptoms are always visual. As a consequence of the inadequate functioning of the detached portion of the retina, in an initial phase, which is when the tear occurs, the first noticeable symptom felt by the patient is the sudden and intense appearance of floaters or dark spots that change position when the eye is moved.
These are shadows that are projected on the retina, due to the vitreous gel filtering through the first tears. The appearance of these spots in the vision does not necessarily imply any problem, but if they occur in a striking way, it is of vital importance to have an ophthalmologic evaluation immediately to determine their causes and rule out a possible case of retinal tear or hole in the retina.
As the retinal detachment progresses, the patient will notice flashes of light, distortion of images, as well as a veil or black cloth covering an area of his visual field, limiting his peripheral vision. In case of suffering from these symptoms, an urgent consultation with the ophthalmologist should be made.
Treatment
Retinal detachment is a pathology of priority attention in ophthalmology, since, if not treated in its early stages, can cause irreparable damage. For this reason, it is necessary for the ophthalmologist to evaluate the extent of the lesion by means of a proper examination in order to decide the recommended treatment. This will depend on the state of the retina, the time elapsed since the first symptoms, as well as the possible causes, among other factors.
Currently, there are different surgical options, depending on whether it is a retinal tear or a retinal detachment. The important thing is that the indicated technique is performed as soon as possible, in order to achieve the best result.
Surgery for a torn retina
The goal is to prevent the tear from progressing to retinal detachment.
- Laser surgery (photocoagulation)
This procedure involves fixing the retina to the back wall of the eye by applying laser around the retinal tears or holes to cauterize and seal the affected area. In this way, the passage of fluids through the tear is blocked, preventing the retina from detaching. This technique is performed on an outpatient basis. - Cryotherapy
The area around the tear is cauterized by applying intense cold.
Surgery for retinal detachment
The objective is to reposition the retina so that it does not permanently lose its ability to function. The method of fixation will depend on the characteristics of the detachment:
- Pneumatic retinopexy
This is an outpatient technique that consists of introducing a gas bubble inside the eye, whose pressure allows repositioning the detached retina. The injected gas is reabsorbed by itself and gradually disappears. - Scleral surgery
Silicone elements are placed and sutured over the sclera, where the tears that have caused the retinal detachment usually occur. This procedure is usually combined with laser or cold to seal these tears. - Vitrectomy
Consists of removing the transparent gel (vitreous humor) that fills the eyeball to access the retina and treat the abnormal vessels that can exert traction on it, with the risk of tearing and producing a retinal detachment. During surgery, in some patients a bubble of gas, oil or other substances is injected into the eye cavity, which helps to keep the retina in place, favoring its repair. This procedure must be performed in the operating room. This ocular microsurgical technique also requires the application of laser or cold on the tears and may occasionally be combined with scleral surgery.
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