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The retina is a transparent neurologic tissue in the back of the eye that sends images to the brain for sight. A retinal detachment is the separation of this light sensitive membrane from its supporting layers. There are three main types of retinal detachments. The most common is a retinal detachment associated with a tear or hole in the retina. Fluid can then leak behind the retina and dissect it off the supporting layers below. This is like wallpaper peeling off a wall. A retinal detachment from a hole or tear is called a rhegmatogenous retinal detachment. These holes or tears may occur from injury or trauma to the eye including posterior vitreous detachments, which is the separation of the vitreous jelly from the retina. If the tear or hole involves a blood vessel, it can bleed into the eye, also causing loss of vision.
Tractional retinal detachment occur when there is scar tissue that pulls the retinal off the underlying supporting tissues. This can in turn cause holes and tears to develop as well. Scar tissue on the retina can develop from injury, inflammation or neovascularization. The most common causes of tractional retinal detachments are from previous retinal detachments and advanced diabetic retinopathy.
The third type of retinal detachment is an exudative retinal detachment. This is caused by leakage of fluid from underlying tissue without any retinal breaks. This can be caused by tumors under the retina and other diseases of the tissue layers underneath the retina.
Risks for developing retinal detachments include:
1. Laser in office to wall off a small detachment to prevent it from spreading. This is performed with or without pneumatic retinopexy- which involves injecting gas or air into the eye to steam roll the retina back onto the underlying tissue. In order to have the gas push against the area of detachment, special head positioning is needed.
2. Scleral buckling surgery in the operating room. A band is placed around the wall of the eye to help keep the retina attached much like a belt used to keep one’s pants up from the outside pressing in.
3. Vitrectomy surgery in the operating room with or without scleral buckling. Vitrectomy involves the removal of the vitreous jelly, identifying and treating all holes and tears to prevent further fluid dissection of the retina. Gas and laser as well as silicone oil are used to keep the retina attached.
Retinal detachments may first appear as dark spots in the vision or by a curtain coming down disrupting vision. Without rapid diagnosis and treatment, the entire retina may detach leading to severe vision loss and blindness.
Surgery can help prevent severe vision loss and the earlier a detachment is diagnosed and treated the better the outcomes in vision. Exactly what the visual outcome will be after treatment is impossible to predict. If the macula, the center of the retina with the sharpest vision, is not involved in the detachment, the visual outcome is better. Detachments with scarring have a worse visual prognosis overall and may need secondary surgeries to repair the retina.
Usually visual recovery can be seen in the first 3 months and continue to improve up to even over 2 years.