Retinal Detachment

DEFINITION: By covering the internal part of the eye, the retina is the layer which communicates with the brain (the network layer) by signalling the vision through the optic nerve. The vitreous, which fills the inside of the eye is of a gel consistency and with ageing or as a result of some eye diseases, it loses the properties of vitreous tissue and starts to liquefy. As a result, the retina separates from its points of attachment. Most of the time, no problems develop during this process, but occasionally during this separation, one or more areas of the retina may be torn. The liquefied vitreous passing from these torn areas may separate from the retinal layer and the disease known as retinal detachment develops. Vision is permanently severely affected and thus this disease must be treated promptly.

Figure 1. Fundus photography of a patient diagnosed with regmatogen retinal detachment (left) and the other healthy eye of the same patient (right).

CAUSES and RISK FACTORS: The most significant cause is ageing. In addition, other risk factors are known to be having undergone cataract surgery, application of YAG laser capsulotomy (performed to clean the lens capsule which has become foggy following cataract), myopia, retinal detachment in the other eye, family history and  trauma history.

FINDINGS: At the beginning of the development of retinal detachment, patients have complaints of flashes and stains of different densities in the field of vision (elliptic-circular shapes, thread-like stains, web-like images, red or black spots). These stains are often intra-vitreous bleedings resulting from retinal vessel tears during the detachment. In the end, loss of vision develops in the detached retina area. The severity of symptoms may differ according to the type, place, and time of detachment. Intraocular pressure in the eye with retinal detachment is lower than in the healthy eye. It is observed in biomicroscopy that cells are frequent in the vitreous. The torn and detached retina appears swollen and white in fundus examination and it undulates with eye movements.

Figure 2. Fundus photography of a patient diagnosed with proliferative vitreoretinopathy and tractional retinal detachment secondary to uncontrolled diabetes.

DIAGNOSTIC TESTS: Diagnosis is made with retinal examination as retinal tears are determined by opthalmoscope. A detached retina appears swollen and white and moves freely with eye movements. In cases with intensive bleeding, ultrasonography is used to determine detachment, rather than fundus examination.

TREATMENT: The ideal treatment in retinal tears is to treat the tear in the patient before retinal detachment develops. Treatment in this period is easier and cheaper and has a higher chance of success. This operation is often painless and can be carried out in the clinic. Laser photocoagulation treatment and cryotherapy can be applied to repair the tears. Some weak and unstructured areas that may be torn in the future can be secured with laser photocoagulation treatment. This laser treatment creates a burn in the application area and attaches the retina to the pigment layer underneath, thereby preventing leakage from the tear. 

The treatment for patients with retinal detachment is surgery. There are different surgical methods. Pneumatic retinopexy (injecting enlargeable gases into the eye), scleral enclosure and/or buckling surgery (collapsing the torn area by placing a type of silicone on the torn area or around the eye), and pars plana vitrectomy (the technique where the retina is entirely attached by entering the eye and applying laser photocoagulation around the tears and tampon material into the eye) can be applied depending on the condition of retinal detachment. When detachment is not fully corrected, further surgery may be required. Patients who have had gas applied to the eye will need to remain fface-down for a certain period and until the gas has disappeared, it is risky to take flights or go to places of high altitude. Following detachment surgery, visual recovery may take a long time and sometimes may not fully recover. In some patients, vision remains at the preoperative level.

Figure 3. Preoperative (left) and postoperative (right) fundus photography of a patient operated with the diagnosis of concomitant retinal detachment and macular hole at our hospital.