Retinal detachment consists of the separation of the innermost layer that forms the eye and processes vision, the retina, which is displaced into the vitreous humor and causes a loss of vision.
What is the retina and what are its parts?
The retina is a group of nerve cells located in the innermost layer of the eye, whose mission is to transform light stimuli into nerve signals to be interpreted by the brain. The macula is an area of the retina that captures central vision, allowing us to focus our attention on details, see close-up and read. The rest of the retina is responsible for peripheral vision. The vitreous humor is a gel that fills the eyeball and is in contact with the retina. With aging or disease, the vitreous humor liquefies, forming lumps in the gel.
Types of retinal detachment
As several ophthalmologists explain, the most frequent retinal detachment is produced by a tear or hole in the retina, allowing the liquid inside the eyeball to enter through these breaks and separate the retina from the underlying tissue, favoring retinal detachment.
Detachment can also occur by traction. This is less frequent and generally affects diabetics, forming membranes that pull the retina towards the vitreous.
Serous retinal detachment is rarer and is caused by inflammation of the outer layers of the retina producing fluid that accumulates under the retina and detaches it. Myopia, diabetic retinopathy, ocular trauma, retinal holes and complicated cataract surgery can also predispose to retinal detachment.
What are the symptoms of retinal detachment?
The symptoms are loss of vision, vision of a cloth or a shadow that may appear without warning, although it is usual to notice the presence of floaters or flashes beforehand.
Floaters are spots that move in the visual field and are usually of no importance. They are usually due to the aging of the vitreous humor that can cause a posterior vitreous detachment, which is an area of the vitreous that separates from the retina and must be controlled. If flashes are observed, it indicates traction of the vitreous on the retina.
How is retinal detachment diagnosed and treated?
Retinal detachment cannot be seen by simply observing the eye. If you detect any of these symptoms, you should see an ophthalmologist for an eye examination to determine the size, location and degree of evolution of the retinal detachment.
The treatment of retinal detachment is aimed at restoring the normal position of the retina, which is why surgery is used in many cases. In tears and holes without detachment, laser is used to surround them and prevent detachment.
– Retinal lesions are treated by laser photocoagulation, a technique that is generally painless but can be uncomfortable at times and is performed on an outpatient basis.
– In cases of superior and small retinal detachments, it can be treated with a gas injection and then laser around the detachment.
– When the lesions cannot be treated with laser, surgery will be necessary, which may be extrascleral, placing implants that push around the eyeball and draining the fluid that causes the retina to be detached. In most cases, vitrectomy surgery is performed inside the eyeball, aiming at the anatomical reapplication of the retina. In spite of the treatment, sometimes it is not possible to fully recover vision even if the retinal anatomy is restored.
The process of retinal detachment surgery
Before surgery, it is necessary to perform some tests and preparations in order to avoid unforeseen situations that may cause complications in the results. Days before the surgery, the eye will be checked to assess the state of the retina and in case of a cataract, it will be operated in the same intervention.
Vitrectomy surgery is performed under sedation-assisted retrobulbar anesthesia, anesthetizing only the intervened eye. It can also be performed under general anesthesia to keep the patient completely asleep throughout the procedure.
Before starting the surgery, the eye area is cleaned with an antiseptic solution and kept open with a blepharostat. The first step consists of making 3 entrances in the sclera, about 3 mm from the cornea, through which the instruments will be introduced.
During surgery, depending on the case, perfluorocarbon may be used to reapply the retina and drain the fluid under the retina. Once the retina has been applied, membranes over the retina can be removed by applying laser or cryotherapy to seal it.
In some cases, surgery can be performed or vitrectomy can be combined with the placement of a silicone band around the eyeball in the same surgical procedure. The silicone oil is the liquid that keeps the retina applied after surgery, in some cases it may remain inside the eye for a long time, but it is usually removed after six months. When the silicone oil is removed, the retina may detach again, so if it is believed that there is a high risk of this happening, it can be left inside the eye, although in the long term it may cause complications such as corneal opacity and glaucoma.
After the operation, the incision is closed with or without stitches and anti-inflammatory and antibiotic treatment can be administered around the eye, leaving it covered. In the first moments after surgery, vision is very poor.
Care after retinal detachment surgery
Normally, the patient is discharged after he/she has tolerated feeding by mouth. An operated patient should not drive or leave the center alone. As soon as the patient is able to do so, he/she should lie on his/her stomach so that the gas expands and holds the retina. In addition, this posture moves the gas away from the lens, since this is conducive to the appearance of cataracts, in cases where the patient has not had cataract surgery.
Antibiotic and anti-inflammatory eye drops are used for several days after surgery, which can be administered one after the other, waiting at least 5 minutes between them. During this time, rest must be strictly maintained and the indicated treatment must be followed. The average recovery period ranges from one to three months, and after six months the results can be evaluated.