Retinal detachment

The retina is the posterior layer of the eye and it transforms the light and images entering the eye into nerve signals that are sent to the brain. Retinal detachment occurs when the neurosensory retina (the layer where the light sensitive cells are located) separates from the pigmentary epithelium and liquid accumulates in the space between them. This means nutrition and blood flow to the neurosensory retina is cut off, which can, on occasions, lead to an irreversible loss of vision.

Retinal detachment risk factors

• Severe short-sightedness
• A personal or family history of retinal detachment
• Other eye conditions
• A case history of ocular contusion injury, trauma or complicated cataract surgery

It has an incidence rate of 1 in 15,000 and can occur at any age.

The symptoms of retinal detachment are very varied and may coexist in the same patient.

• Eye floaters (myodesopsia)
  When they appear or suddenly get larger compared to pre-existing ones.
• Flashes of light (photopsia)
  Especially if they are repetitive or appear in the same area of the visual field.
• Dark curtain
  Appearance of a dark curtain that appears gradually and covers the eyesight.
• Seeing distorted images
  With a reduction in visual acuity, when the central part of the retina (macula) is affected.

Sudden appearance of any of the symptoms described, especially flashes of light, already indicate that the retina is torn or broken, but when treated early with retinal photocoagulation, the patient will avoid subsequent retinal detachment.

In the event that retinal detachment has already been determined, treatment will almost always entail surgery and not undergoing it immediately could lead to irreversible loss of vision.

It is important to get regular check-ups, at least once a year, particularly for populations at risk. It is also essential to review the retina of the contralateral eye of patients with a personal history of retinal detachment, in order to detect at-risk peripheral lesions and give them pre-emptive treatment before the disease starts to set in.

Treatment is almost always surgery. There are two surgical techniques that can be used separately or combined.

• Scleral buckle surgery involves putting a silicone band, like a “belt” around the sclera. The band squeezes the eyeball and the application of cryocoagulation or laser photocoagulation helps the detached retina to re-attach.
• A pars plana vitrectomy aims to reattach the retina “from inside” by removing the vitreous gel and the tractions caused by tears to the retina and, as a result, the detachment. Treatment for the tear involves using photocoagulation or cryocoagulation to cause scarring and thus seal the neurosensory retina to the pigmentary epithelium.

In the majority of cases, treatment cures retinal detachment although in some isolated cases, several surgical procedures may be required.