What is retinal detachment?
A retinal detachment is an uncommon but serious eye condition in which the retina separates from the inner lining within the eye often associated with holes or tears in the retina.
Causes of retinal detachments
There are many causes of retinal detachments but most do not have any clear precipitating factor. About 400 per year occur in New Zealand and they are more common in patients with myopia (short sightedness) and those with a family history of retinal detachment. They rarely follow intraocular surgery such as cataract surgery.
Symptoms of retinal detachment
The early symptoms of a detachment may include flashes of light and the sudden appearance of floaters. Many people have floaters which have been present for many years and are not a cause for concern. If a retinal detachment progresses, a visual field defect can usually be demonstrated. People often use the expression of a "curtain" or "shadow" appearing in their vision and such a symptom should be taken seriously.
Degree of urgency
Patients with symptoms of retinal detachment should be evaluated as a matter of some urgency. If the shadow does not involve the central field of vision, retinal detachment repair should be carried out as soon as possible. If the central vision has already been lost the timing of surgery is less acute.
Surgery for retinal detachment
The surgical principles involve reattaching the retina on the inside of the eye. This usually necessitates the use of a laser to "spot weld" the retina back on and often a gas bubble is placed inside the eye to help stabilise the retina whilst it is healing.
If a gas bubble is used the surgeon will often require the patient's head to be postured in such a way that the bubble is placed in a position to support the healing retina. The gas usually takes about 10 days to resorb and air travel is not possible during this period.
Success of surgery
Repairing a detached retina is not always successful. In some eyes the retina may re-detach due to the development of new retinal tears or scarring on the surface of the retina and this may necessitate another operation. Sometimes even when the retina is successfully reattached the vision may remain poor due to irreversible damage to the retinal cells.
Any patient with a retinal detachment should understand the approximate percentages of successful surgery and the likelihood of obtaining good central vision.