Retinal Detachment

What is Retinal Detachment?

Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium.

Retinal Detachment Symptoms

• Very brief flashes of light (photopsia) in the extreme peripheral (outside of center) part of vision
• A sudden dramatic increase in the number of floaters
• A ring of floaters or hairs just to the temporal side of the central vision
• Seeing a veil like curtain starting from the sides and progressing to the central vision
• The impression that a veil or curtain was drawn over the field of vision
• Distortion of vision occurs which causes straight lines to appear bent or curved Central visual loss

Causes of Retinal Detachment

• Rhegmatogenous Detachment. Risk factors include the following:
• Myopia
• Previous cataract surgery
• Ocular trauma
• Lattice retinal degeneration
• A family history of retinal detachment

Tractional Retinal Detachment can be caused by vitreoretinal traction due to preretinal fibrous membranes as may occur in proliferative diabetic or sickle cell retinopathy.

Serous Detachment results from transudation of fluid into the Subretinal space. Causes include severe uveitis, especially in Vogt-Koyanagi-Harada disease, choroidal hemangiomas, and primary or metastatic choroidal cancers

Retinal Detachment Prevention

• Avoid direct and indirect injury to the eyes
• Regular eye check up
• Controlling systemic risk factors and diseases such as diabetes

Retinal Detachment Diagnosis

• Ophthalmoscopy preferably with indirect ophthalmoscope
• Fundus photography
• Ultrasound B scan

Retinal Detachment Treatment

• Retinal laser photocoagulation and cryopexy
• Scleral buckle surgery
• Pneumatic retinopexy
• Vitrectomy surgery

Rhegmatogenous detachment is treated with one or more methods, depending on the cause and location of the lesion. These methods involve sealing the retinal breaks by laser or cryotherapy. In scleral buckling, a piece of silicone is placed on the sclera, which indents the sclera and pushes the retina inward, thereby relieving vitreous traction on the retina. During this procedure, fluid may be drained from the subretinal space. Pneumatic retinopexy (intravitreal injection of gas) and vitrectomy are other treatments. Laser photocoagulation using green Argon, red Krypton or Diode laser or cryopexy ( scarring the retinal tear by freezing) can help in treating retinal breaks. Surgical treatment is successful in most of the cases of rhegmatogenous retinal detachments.

Vitrectomy may be the treatment of choice for non rhegmatogenous retinal detachments due to vitreo retinal traction. Systemic corticosteroids or systemic immunosuppressive drugs (eg, methotrexate, azathioprine) are used to treat transudative detachments. Alternatively, transudative detachments due to uveitis can be treated locally with a periocular corticosteroid injection, intravitreal corticosteroid injection, or an intravitreal dexamethasone implant. Primary and metastatic choroidal cancers also require treatment. Photodynamic therapy or rarely laser photocoagulation are used for treating choroidal hemangiomas.