Retinal detachment superior tear

Retinal detachment

Table of Contents

What is a retinal detachment?

Rhegmatogenous retinal detachment affects 1 in every 10,000 people each year, and both eyes can be affected in about 10% of cases. Retinal detachment is characterized by the presence of a peripheral retinal rupture that is kept open by the traction of the internal gel of the eye, which allows for the accumulation of fluid under the retina and the subsequent retinal detachment.

More than 40% of all retinal detachments occur in patients with myopia. The risk is inversely proportional to the prescription, meaning that patients with higher myopia have a greater risk of retinal detachment. Before a retinal detachment, these patients may present with lesions such as tears or holes in the retina that can only be diagnosed during a consultation with a specialist.

Myopic patients that have had corrective surgery are still at risk of a retinal detachment because this type of refractive surgery only modifies the cornea or lens that is found in the front of the eye (whereas the retina is located in the back of eye).

Macula-on retinal detachment = EMERGENCY. There is a higher probability of achieving better visual outcomes in macula-on rhegmatogenous retinal detachments.
Retinal detachment with partially detached macula = EMERGENCY

Symptoms

The main symptoms described by 60% of patients with retinal detachment are floaters and flashes (lights). As time goes by, the patient begins to notice blurred vision or a black curtain, until the patient loses all vision.

Retinal detachment itself is painless.

Retinal tear treated with laser. This patient started with floaters and flashes and went immediately to the office before the retina detached.

Risk factors

The following factors increase your risk of retinal detachment:

  • Aging – retinal detachment is more common in people over 50
  • Myopia
  • Previous eye surgery, especially cataract surgery or intraocular lens implantation
  • Previous severe eye injury
  • Previous other eye problems, including retinoschisis, inflammation (uveitis) or thinning of the peripheral retina (lattice degeneration)
  • Family history of retinal detachment

If you have had cataract surgery, intraocular lens implant or lasik and experience a ‘curtain’ blocking your vision, new floating spots in your vision, or flashes of light across your vision, this could indicate that you have suffered retinal detachment and you should contact your ophthalmologist immediately

Patient with trifocal intraocular lens implant to treat presbyopia.

Diagnosis

Retinal examination. The doctor may use an instrument with a bright light and special lenses to examine the back of your eye, including the retina. This type of device provides a highly detailed view of your whole eye, allowing the doctor to see any retinal holes, tears or detachments.


Ultrasound imaging. Your doctor may use this test if bleeding has occurred in the eye, making it difficult to see your retina.


Your retina specialist will likely examine both eyes even if you have symptoms in just one. If a tear is not identified at this visit, your doctor may ask you to return within a few weeks to confirm that your eye has not developed a delayed tear as a result of the same vitreous separation. Also, if you experience new symptoms, it’s important to return to your doctor right away.

Indirect ophthalmoscopy provides the doctor with a greater depth of focus, a more brilliant picture, and a full field of view of your retina

Treatment

The goal of treatment is to successfully repair the retinal detachment with minimal trauma and associated risks.

The main procedures to treat problems affected the retina include: pneumatic retinopexy, scleral buckle, and victretomy.

Pneumatic retinopexy or pneumopexy is an outpatient procedure in which a gas bubble is used that expands inside the eye to close a retinal rupture and adhere the retina without opening the eye. It can be performed in the office and is minimally invasive but the success rate is lower than scleral buckling or a vitrectomy (described below). This procedure is usually reserved for the treatment of uncomplicated detachments with a small superior retinal rupture.

The scleral buckle is a surgical procedure in which a sponge or band is sutured to the walls of the eye creating an indentation or internal depression. The purpose of this procedure is to close retinal breaks by positioning the wall of the eyeball to the retina and to reduce the traction of the internal gel that caused the break. The scleral buckle is placed around the entire circumference of the eye to create a 360° closure.

Scleral buckle

Although the majority of retinal detachments are simple and can be satisfactorily treated with a scleral buckle, a vitrectomy offers a greatly improved prognosis for more complex detachments. A vitrecomy is a surgery performed inside of the eye using ports through which light, cut, and suction probes enter. A vitrecomy is suggested in cases where the retinal breaks can not be visualized, and in cases of retinal detachments in which the retinal breaks can not be treated with a scleral explant in a single procedure (which are usually detachments involving giant tears or posterior tears).

At Retina Center we have performed more than 5,000 surgeries, mainly retinal detachment and diabetes complications. We have the best technology on the market. Here you can see some examples of patients we have operated on. In addition to our videos on YouTube.

One of the most complex cases of retinal detachment operated by Dr. Aureliano Moreno. See the video below.
Complex retinal detachment in a boxer patient
Retinal detachment before surgery
Retinal detachment after surgery
After surgery and regained their vision
Macula off retinal detachment
RD before vitrectomy
retinal detachment after vitrectomy
3 weeks after vitrectomy

MAKE SURE TO VISIT A RETINA SPECIALIST IF YOU A HISTORY OF ANY OF THE FOLLOWING CONDITIONS:

  • MYOPIA
  • FLOATERS AND FLASHES
  • CATARACT SURGERY
  • DIABETES
  • FAMILY HISTORY OF RETINAL DETACHMENT
  • OCULAR TRAUMA

Don’t forget to visit our YouTube channel to see more surgeries like this:

Vitrectomy for total retinal detachment
Entrevista para Televisa “Todo Acerca del Desprendimiento de Retina”

Additional information: Mayo Clinic Guide

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