Retinal detachment Prevalence

Retinal detachment is a disorder of the The risk of retinal detachment in

eye in which the retina peels away from otherwise normal eyes is around 5 in
its underlying layer of support tissue. 100,000 per year. Detachment is more
Initial detachment may be localized, but frequent in the middle-aged or elderly
without rapid treatment the entire retina population with rates of around 20 in
may detach, leading to vision loss and 100,000 per year. The lifetime risk in
blindness. It is a medical emergency. normal eyes is about 1 in 300.

The retina is a thin layer of light • Retinal detachment is more

sensitive tissue on the back wall of the common in those with severe
eye. The optical system of the eye myopia (above 5–6 diopters), as
focuses light on the retina much like their eyes are longer and the
light is focused on the film in a camera. retina is stretched thin. The
The retina translates that focused image lifetime risk increases to 1 in 20.
into neural impulses and sends them to Myopia is associated with 67%
the brain via the optic nerve. of retinal detachment cases.
Occasionally, posterior vitreous Patients suffering from a
detachment, injury or trauma to the eye detachment related to myopia
or head may cause a small tear in the tend to be younger than non-
retina. The tear allows vitreous fluid to myopic detachment patients.
seep through it under the retina, and
peel it away like a bubble in wallpaper. • Retinal detachment can occur
more frequently after surgery for
cataracts. The estimated of risk
Types
of retinal detachment after
cataract surgery is 5 to 16 per
• Rhegmatogenous retinal 1000 cataract operations. The
detachment – A risk may be much higher in those
rhegmatogenous retinal who are highly myopic, with a
detachment occurs due to a frequency of 7% reported in one
hole, tear, or break in the retina study. Young age at cataract
that allows fluid to pass from the removal further increased risk in
vitreous space into the subretinal this study. Long term risk of
space between the sensory retinal detachment after
retina and the retinal pigment extracapsular and
epithelium. phacoemulsification cataract
• Exudative, serous, or surgery at 2, 5, and 10 years
secondary retinal was estimated in one study to be
detachment – An exudative 0.36%, 0.77%, and 1.29%,
retinal detachment occurs due to respectively.
inflammation, injury or vascular
abnormalities that results in fluid • Tractional retinal detachments
accumulating underneath the can also occur in patients with
retina without the presence of a proliferative diabetic retinopathy
hole, tear, or break. or those with proliferative
• Tractional retinal retinopathy of sickle cell disease.
detachment – A tractional In proliferative retinopathy,
retinal detachment occurs when abnormal blood vessels
fibrovascular tissue, caused by (neovascularization) grow within
an injury, inflammation or the retina and extend into the
neovascularization, pulls the vitreous. In advanced disease,
sensory retina from the retinal the vessels can pull the retina
pigment epithelium. away from the back wall of the
eye causing a traction retinal
A substantial number of retinal detachment.
detachments result from trauma,
including blunt blows to the orbit, Although retinal detachment usually
penetrating trauma, and concussions to occurs in one eye, there is a 15%
the head. A retrospective Indian study of chance of developing it in the other eye,
more than 500 cases of and this risk increases to 25–30% in
rhegmatogenous detachments found patients who have had cataracts
that 11% were due to trauma, and that extracted from both eyes.
gradual onset was the norm, with over
50% presenting more than one month
after the inciting injury.
WHAT CAUSES RETINAL • straight lines (scale, edge of the
DETACHMENT? wall, road, etc.) that suddenly
appear curved (positive Amsler
A clear gel called vitreous fills the grid test)
middle of the eye. As we get older, the • central visual loss
vitreous may pull away from its
attachment to the retina at the back of (None of this is to be confused with the
the eye. broken retina which is generally the tearing
of muscle and nerve behind the eye)
Usually the vitreous separates from the
retina without causing problems. But
Treatment of Retinal Detachment
sometimes the vitreous pulls hard
enough to tear the retina in one or more
places. Fluid may pass through the There are several methods of treating a
retinal tear, lifting the retina off the back detached retina which all depend on
of the eye, much as wallpaper can peel finding and closing the breaks which
off a wall. have formed in the retina. All three of
the procedures follow the same 3
The following conditions increase the general principles:s
chance of having a retinal detachment:
1. Find all retinal breaks
• nearsightedness; 2. Seal all retinal breaks
• previous cataract surgery; 3. Relieve present (and future)
• glaucoma; vitreoretinal traction
• severe injury;
• previous retinal detachment in • Cryotherapy and Laser
your Photocoagulation

other eye; Cryotherapy (freezing) or laser

photocoagulation are
• family history of retinal occasionally used alone to wall
detachment; off a small area of retinal
• weak areas in your retina that detachment so that the
can been seen by your detachment does not spread.
ophthalmologist
• Scleral buckle surgery
Symptoms
Scleral buckle surgery is an
A retinal detachment is commonly established treatment in which
preceded by a posterior vitreous the eye surgeon sews one or
detachment which gives rise to these more silicone bands (bands,
symptoms: tyres) to the sclera (the white
outer coat of the eyeball). The
• flashes of light (photopsia) – very bands push the wall of the eye
brief in the extreme peripheral inward against the retinal hole,
(outside of center) part of vision closing the break or reducing
• a sudden dramatic increase in fluid flow through it and reducing
the number of floaters the effect of vitreous traction
• a ring of floaters or hairs just to thereby allowing the retina to re-
the temporal side of the central attach. Cryotherapy (freezing) is
vision applied around retinal breaks
• a slight feeling of heaviness in prior to placing the buckle. Often
the eye subretinal fluid is drained as part
of the buckling procedure. The
Although most posterior vitreous buckle remains in situ. The most
detachments do not progress to retinal common side effect of a scleral
detachments, those that do produce the operation is myopic shift. That is,
following symptoms: the operated eye will be more
short sighted after the operation.
Radial scleral buckle is indicated
• a dense shadow that starts in the
to U-shaped tears or Fishmouth
peripheral vision and slowly
tears and posterior breaks.
progresses towards the central
Circumferential scleral buckle
vision
indicated to multiple breaks,
• the impression that a veil or
anterior breaks and wide breaks.
curtain was drawn over the field
Encircling buckles indicated to
of vision
breaks more than 2 quadrant of
retinal area, lattice degeration
 located on more than 2 quadrant Results of Surgery
of retinal area, undetectable
breaks, and proliferative vitreous 85 percent of cases will be successfully
retinopathy. treated with one operation with the
remaining 15 percent requiring 2 or
• Pneumatic retinopexy more operations. After treatment
patients gradually regain their vision
This operation is generally over a period of a few weeks, although
performed in the doctor's office the visual acuity may not be as good as
under local anesthesia. It is it was prior to the detachment,
another method of repairing a particularly if the macula was involved in
retinal detachment in which a the area of the detachment. However, if
gas bubble (SF6 or C3F8 gas) is left untreated, total blindness could
injected into the eye after which occur in a matter of days
laser or freezing treatment is
applied to the retinal hole. The Prevention
patient's head is then positioned
so that the bubble rests against  Educating people to seek
the retinal hole. Patients may ophthalmic medical attention if
have to keep their heads tilted they suffer symptoms suggestive
for several days to keep the gas of a posterior vitreous
bubble in contact with the retinal detachment
hole. The surface tension of the
 Early examination allows
air/water interface seals the hole
detection of retinal tears which
in the retina, and allows the
can be treated with laser or
retinal pigment epithelium to
cryotherapy. This reduces the
pump the subretinal space dry
risk of retinal detachment in
and suck the retina back into
those who have tears from
place. This strict positioning
around 1:3 to 1:20
requirement makes the
treatment of the retinal holes and  Activities which can cause direct
detachments that occurs in the trauma to the eye (boxing,
lower part of the eyeball kickboxing, karate, etc.) may
impractical. This procedure is cause a particular type of retinal
usually combined with cryopexy tear called a retinal dialysis. This
or laser photocoagulation. type of tear can be detected and
treated before it develops into a
retinal detachment. For this
• Vitrectomy
reason governing bodies in
some of these sports require
Vitrectomy is an increasingly regular eye examination.
used treatment for retinal
 avoid activities where there is a
detachment. It involves the
risk of shock to the head or eyes,
removal of the vitreous gel and is
although without direct trauma to
usually combined with filling the
the eye the evidence base for
eye with either a gas bubble (SF6
this may be unconvincing
or C3F8 gas) or silicon oil.
 Activities that involve sudden
Advantages of using gas in this
acceleration or deceleration also
operation is that there is no
increase eye pressure and are
myopic shift after the operation
discouraged by some doctors.
and gas is absorbed within a few
These include bungee jumping
weeks. Silicon oil (PDMS), if
filled needs to removed after a
period of 2–8 months depending
on surgeon's preference. Silicon
oil is more commonly used in
cases associated with
proliferative vitreo-retinopathy
(PVR). A disadvantage is that a
vitrectomy always leads to more
rapid progression of a cataract in
the operated eye. In many
places vitrectomy is the most
commonly performed operation
for the treatment of retinal
detachment.