Retinal Detachment

Retinal Detachment

What is a Retinal Detachment? 

A retinal detachment  is a rare serious condition affecting an important part of the eye.  The retina is equivalent to the film in a camera and lines the inside of the back and sides of the eye.  If fluid goes under the retina it lifts it forward and the retina is said to be detached.

How do retinal detachments occur?                                                                                                                             

Most retinal detachments are due to fluid traveling from the vitreous, which is a watery gel like material filling most of the inside of the eye, through holes in the edge of the retina so that the retina is separated from the back of the eye so cutting it off from its oxygen supply.  Retinal holes mostly occur spontaneously and are only rarely due to an injury.  They are quite common and only occasionally cause a retinal detachment.  Myopic/short-sighted people and those who have had cataract operations have a slightly greater risk.

Treatment

A successful operation depends on sealing the hole or holes in the retina.  Very often the fluid under the retina is removed too but this is less important as the eye itself has cells which pump this space dry provided the ‘punctures’ in the retina are sealed.  This is usually done by attaching small pieces of plastic to the outside of the eye at the side thus creating a bump on the inside of the eye which lines up with the retinal hole.  Sometimes air or a special gas is used inside the eye which has the same effect.  The vitreous gel may be removed to allow a better gas fill.  This operation is called a Vitrectomy.  The gas is temporary and dissolves into the blood stream with time.  Silicone oil can be used as a permanent vitreous replacement and may need to be removed months later at a second operation.

The success rate for attaching the retina.

In one operation is about 90% in a straightforward case.  In other words 1 in 10 will not respond to one operation and will require further surgery.  The success rate is lower at about 80% after one operation in patients who have previously had cataract surgery.  As one might expect there are other difficult situations where the success rate is lower for example when the retina becomes shrunken and scarred, and when the retinal tears are many or large.  Sadly not all cases are treatable and some eyes will therefore become blind.

The operation itself.

The operation is normally done under general anaesthetic and takes between one and two hours.  The eye is NOT removed although this ridiculous untruth appears from time to time in magazines and newspapers.  In fact as the operation is essentially on the side of the eye access during the operation is quite easy.

Afterwards.

There will be some pain or discomfort which should be easily controlled with painkillers.  The eye will be red and will probably feel gritty as though something was in it.  The eyelids are often swollen and you may have difficulty opening the eye at first.  The sight will initially be extremely blurred particularly if gas has been used in the eye.  The discomfort should settle within two to four weeks after the operation.  Any severe pain in the eye or further loss of vision should be urgently reported as this can be a symptom of infection.

Recovery of Sight.

After a successful retinal reattachment is variable and some patients do better than others.  Peripheral vision, that is the overall sensation of seeing, usually returns quite quickly, but if the central part of the retina called the macula, has been involved then recovery of fine detailed vision such as is needed to read, is slow (6 to 9 months) and incomplete.  In other words the sight does not return to normal.  If the macula has not been detached at any stage then fine vision should remain good.

Post-op instructions.

There is no ban on bending straining or moderate lifting but avoid prodding or rubbing the eye. Ask the doctor about driving but in any case not for the first week. If there is gas in the eye you may be given specific posture instructions to help keep the gas bubble in the correct place in the eye.   DO NOT FLY IN AN AEROPLANE WHILE GAS REMAINS IN THE EYE, the gas will expand as the plane ascends – even in a pressurised aircraft – and the eye will become severely painful and possibly permanently blind.  Air travel is perfectly acceptable after the gas has dissolved or if gas has not been used.

Finally.

All detachments are different and each poses a unique challenge to the surgeon.  You will have chance to discuss your particular case and the doctor will gladly answer any questions.

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“The more boundless your vision, the more real you are.”    Deepak Chopra