Retinal Detachment

Retinal detachment occurs when a break (tear or hole) in the retina allows fluid from the vitreous humor to enter the potential space beneath the retina. This causes the retina to separate from the layer beneath, known as the retinal pigment epithelium (RPE). This represents an emergency, and surgery is typically scheduled urgently (within 24 to 48 hours of diagnosis).

retinal detachment

Most cases of retinal detachment are associated with a posterior vitreous separation, which is a natural part of aging. This is due to the natural contraction, or shrinkage, of the vitreous humor, which occasionally creates traction on the retina, producing a retinal break (hole or tear). The process of posterior vitreous separation is often accelerated by cataract surgery, trauma, YAG laser capsulotomy following cataract surgery (for a hazy capsule behind the lens implant), diabetes, vitreous hemorrhage, and uveitis (inflammation inside the eye). Certain other conditions predispose one to retinal detachment, such as high myopia (nearsightedness), a peripheral retinal degeneration known as lattice degeneration, and a number of different inherited syndromes.

Patients will often experience flashes of light, floaters, and a curtain-like loss of vision as the retinal detachment ensues. Many patients will present when the retinal detachment involves only the peripheral retina. These patients have the best prognosis for retained vision. Other patients present when central vision is lost, which may represent retinal detachment involving the macula (central retina). Because the macula is responsible for central vision, these patients have a less favorable prognosis than patients with a peripheral retinal detachment. The duration of retinal detachment is critical to the prognosis, i.e., the longer the detachment, the worse the prognosis. The primary surgical methods employed to treat retinal detachment include scleral buckling (placement of an encircling band around the eye), vitrectomy (surgical removal of vitreous humor), and pneumatic retinopexy (injection of a gas bubble into the vitreous cavity combined with cryotherapy of the retinal break).