Retinal detachment is considered an emergency in ophthalmology. The detached neurosensory retina degenerates due to the lack of nourishment. Permanent visual loss ensues if the therapeutic window is missed. If the retinal detachmentinvolves the macula, timely treatment is even more critical.
Rhegmatogenous, Tractional, and Exudative Retinal Detachment
Retinal detachment is classified as rhegmatogenous or non-rhegmatogenous. Rhegmatogenous retinal detachment occurs when there is a break in the retina due to degeneration or vitreous contraction. Fluid enters through the retinal break, causing the neurosensory retina to detach from the retinal pigmented epithelium. This type of retinal detachment is associated withvitreous syneresis,genetic factors, myopia and eye trauma.Patients may experience a sudden shower of floaters, flashes of light, or visual field loss extending from the periphery. On the other hand, non-rhegmatogenousretinal detachment may be related to diabetes mellitus, intraocular inflammation, tumors, etc.
Treatment
For the treatment of retinal breaks, laser photocoagulationor cryotherapy may be used. If retinal detachment has occurred, surgical treatment is often needed.
Types of surgery include:
- Pneumatic Retinopexy. A small gas bubble isinjected into the eye to tamponade the retinal break and support the retina.
- Scleral Buckling. An extraocular implant is used to indent the sclera corresponding to the retinal break
- Pars Plana Vitrectomy. The vitreous is removed to reduce traction on the retina
- Combination of multiple surgical methods
Postoperative Care
A minimally invasive approach to retinal detachment surgery means that it can be performed under general or local anesthesia, and reduces postoperative discomfort. Patients are required to maintain a certain head posturein the immediate postoperative period to facilitate retinal reattachment. The gas bubble injected during surgery may take two to eight weeks to be reabsorbed. Patients are forbidden to take a flight or travel to high altitudes with the gas bubble in-situ, so as to avoid bubble expansion and eye pressure rise. If silicone oil is injected, it may be surgically removed a few monthslater.
