Retinal Detachment

Retinal Detachment


If there is a strong adhesion between the retina and the vitreous, the posterior vitreous detachment can cause a traction on the retina. If the retina itself is fragile at that particular point, this can lead to a retinal tear, which will allow the intraocular fluids to go through and detach the retina.

In the large majority of cases, there is nothing that indicates that a retinal detachment will occur before it actually happens. Physical symptoms perceived by the patient might be flashes of light, a shower of floaters, or a loss of peripheral visual field, that the patient will not notice most of the time until the central vision has been affected. Without rapid surgerical intervention, preferably between eight and fifteen days, the retinal can become retracted, because pigment cells will start to form membranes over the surface of the retina. When the retina is retracted, surgery becomes much more complicated, and the chances of healing are severely diminished.

Surgical Treatment

The first goal of surgical treatment is to stop the fluids from passing through the tear by plugging it. The pumping done by the pigment epithelium allows the retina to be reattached. To do this, the surgeon first needs to find all the tears or holes. No matter how small, in order to induce an inflammatory reaction on the edges of the holes or tears by cryopexy or laser. This reaction will act as a glue when the tear will be pushed against the pigment epithelium. This can be done in several ways: the doctor can reshape the sclera pushing it against the tear, by doing scleral buckle. Using an explant suture to the sclera, he can do an internal tamponing by pushing the retina against the pigment epithelium then injecting a bubble of gas into the eye. This bubble will then be absorbed naturally. For complicated cases, a silicone bubble is sometimes used instead thought it must later be removed. Lastly, he could remove the vitreous tractions that caused the detachment in the first place, thus giving the retina back its flexibility. This is called a vitrectomy, or removal of the vitreous. All of these procedures can be done together, as well as with other complementary steps, like membrane dissection, or removal of the fluid underneath the retina.

The failure rate of the first surgery is always present, because the surgeon cannot completely account for the range of outcomes that can occur with each individual detachment, especially if it is advanced or involves complications. It is necessary to restart the procedure, given that since a healed state is not maintained, the condition continues to contribute to permanent vision loss.

As soon you leave the clinic, you will place eyedrops in your eye. The name of the collyre, the frequency of use, and the duration of the treament will all be stipulated by your original prescription. Certain treatments against pain or inflammation can also be obtained.

If a gas bubble was placed in your eye, your surgeon will ask you to maintain a certain head position for a few days. The goal of this position is to allow the gas bubble to push on the proper part of your retina. This bubble will disappear by itself after several days. During this time, you will see a large black spot in your inferior visual field, as if you were seeing through an aquarium. While the gas bubble is present in your eye, all travel by airplane is forbidden.

To promote proper healing of your retina, is it recommended to avoid movements that can cause ocular shaking. Avoid reading and looking through the window while traveling in the car or train. Avoid straining and sport. However, if the prescribed head position allows, watching television is allowed.
Additionally, you will need to respect a few precautions for at least 15 days:
- Do not irritate your eye; be careful using shampoo and soap and do not use swimming pools.
- Avoid catching a cold and avoid infected people. An ocular infection is a very serious complication which necessitates emergency treatment. If your eye is experiences redness or pain call your surgeon immediately.

Your vision will improve progressively. It might be difficult to appreciate this recovery if a gas bubble is present. However, you should not experience a rapid shadowing of your visual field. If this occurs, phone your surgeon.

A follow up visit with your surgeon will allow him or her to judge the results of the operation. Know that the risk of recurence is always present and that subsequent interventions might be necessary. If all goes well, you can expect a return to normal activity. Visual improvement will be obtained within three to six months after the operation. If present at all, any pain will progressively diminish.

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