Retinal detachment is one of the most serious emergencies affecting our eyes. Normally the retina is adherent to the inner surface of the eye.
In the event of a retinal break or hole, the retina detaches from the eye tissue to which it adheres and shrinks. The retina is thus no longer able to offer the brain an adequate image and one’s vision becomes blurred and reduced (retinal detachment).
Causes of Retinal Detachment
Retinal detachment occurs more frequently in middle-aged subjects with medium-high myopia. Rarely, even young subjects can be affected by spontaneous retinal tears with consequent detachment or following a blunt ocular trauma (post-traumatic retinal detachment).
Over the years, the vitreous gel undergoes a progressive degeneration that leads to vitreous liquefaction over time. This phenomenon is perceived by the patient as flying flies or cobwebs (floaters) in their field of vision.
Over time, this transformation leads the vitreous to detach from the retina, remaining adherent only in the points of greatest adhesion: this is a physiological event, which basically happens to anyone.
The most common symptom of retinal detachment is the vision of a curtain in the visual field.
It is also possible to perceive flashes of light (photopsies) or mobile black points (floaters). There is never pain. Immediate treatment can minimize damage to the eye. If a patient has had a detachment in one eye, the risk of having it in the other eye is slightly higher than average.
Surgery for Retinal Detachment
Retinal detachment therapy must be implemented as quickly as possible to avoid fearful complications such as complete loss of vision, eyeball atrophy, or sometimes, the development of neovascular glaucoma over time. Standard treatments for retinal detachment are:
- Photocoagulation with argon laser. The aim of the therapy is to create a scar around the break that prevents fluid from entering the subretinal space.
- However, when the detachment involves a significant area of the retina, surgery is required. Surgery for retinal detachment essentially involves two approaches:
- from the outside: minimally invasive episcleral surgery.
- from the inside: vitrectomy.
Prevention of Retinal Detachment
It is important to know if there have been previous cases of retinal detachment in the family because there is often a connection down the line. If during the visit, alterations are found at the level of the retinal periphery, the detachment can be prevented by carrying out specific treatments. In many cases, however, adequate prevention is not possible.
Can the Retinal Detachment Be Bilateral?
If a patient has had a detachment in one eye, the risk of having a retinal detachment in the other is 5% above average.
What Will My Vision Be Like After the Surgery?
Visual recovery after retinal detachment surgery is variable and basically depends on whether or not the central part of the retina is involved: the macula. Currently, the results of retinal detachment surgery are very good. Anatomical success with a single operation is predictable in approximately 90% of cases, and with two operations in more than 95% of cases.
Unfortunately, sometimes more than one intervention is necessary, due to an abnormal scarring process that the eye spontaneously sets in motion: proliferative vitreoretinopathy (PVR).
Macula-on detachments are surgical emergencies to be treated as quickly as possible, as the result of the surgery is potentially very good. The patient with retinal detachment but with the attached macula, if successfully operated on, can continue to see very well.
On the other hand, the “macula-off” detachments are deferrable and can be operated on within a few days from the onset of symptoms, without worsening the results. Visual recovery is variable and the reading ability may be compromised at various levels. Statistically, a 50% recovery of vision is achievable in 80% of cases.
Retinal detachment occurs more frequently in middle-aged people with medium to high myopia. It affects around 1 in 10,000 people each year. The most common cause of retinal detachment is the appearance of a retinal tear but other risk factors are high myopia, surgery for cataract extraction, and trauma.