Retinal Detachment
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The retina is the light-sensitive layer of tissue that lines the inside
of the eye and sends visual messages through the optic nerve to the brain.
When the retina detaches, it is lifted or pulled from its normal position.
If not promptly treated, retinal detachment can cause permanent vision
loss.
In some cases there may be small areas of the retina that are torn. These
areas, called retinal tears or retinal breaks, can lead to retinal detachment.
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Symptoms include a sudden or gradual increase in either the number of floaters,
which are little "cobwebs" or specks that float about in your field of vision,
and/or light flashes in the eye. Another symptom is the appearance of a curtain
over the field of vision. A retinal detachment is a medical emergency. Anyone
experiencing the symptoms of a retinal detachment should see an eye care
professional immediately.
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There are three different types of retinal detachment:
Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the retina
allows fluid to get under the retina and separate it from the retinal pigment
epithelium (RPE), the pigmented cell layer that nourishes the retina. These
types of retinal detachments are the most common.
Tractional -- In this type of detachment, scar tissue on the retina's
surface contracts and causes the retina to separate from the RPE. This type
of detachment is less common.
Exudative -- Frequently caused by retinal diseases, including inflammatory
disorders and injury/trauma to the eye. In this type, fluid leaks into the
area underneath the retina, but there are no tears or breaks in the retina.
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A retinal detachment can occur at any age, but it is more common in people
over age 40. It affects men more than women, and Whites more than African
Americans. Retinal detachment also occurs more frequently in people of Jewish
ethnicity.
A retinal detachment is also more likely to occur in people who:
- Are extremely nearsighted
- Have had a retinal detachment in the other eye
- Have a family history of retinal detachment
- Have had cataract surgery
- Have other eye diseases or disorders, such as retinoschisis, uveitis,
degenerative myopia, or lattice degeneration
- Have had an eye injury
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Small holes and tears are treated with laser surgery or a freeze treatment
called cryopexy. These procedures are usually performed in the doctor's office.
During laser surgery tiny burns are made around the hole to "weld" the retina
back into place. Cryopexy freezes the area around the hole and helps reattach
the retina.
Retinal detachments are treated with surgery that may require the patient
to stay in the hospital. In some cases a scleral buckle, a tiny synthetic
band, is attached to the outside of the eyeball to gently push the wall of
the eye against the detached retina. If necessary, a vitrectomy may also
be performed. During a vitrectomy, the doctor makes a tiny incision in the
sclera (white of the eye). Next, a small instrument is placed into the eye
to remove the vitreous, a gel-like substance that fills the center of the
eye and helps the eye maintain a round shape. Gas is often injected to into
the eye to replace the vitreous and reattach the retina; the gas pushes the
retina back against the wall of the eye. During the healing process, the
eye makes fluid that gradually replaces the gas and fills the eye. With all
of these procedures, either laser or cryopexy is used to "weld" the retina
back in place.
With modern therapy, over 90 percent of those with a retinal detachment
can be successfully treated, although sometimes a second treatment is needed.
However, the visual outcome is not always predictable. The final visual result
may not be known for up to several months following surgery. Even under the
best of circumstances, and even after multiple attempts at repair, treatment
sometimes fails and vision may eventually be lost. Visual results are best
if the retinal detachment is repaired before the macula (the center region
of the retina responsible for fine, detailed vision) detaches. That is why
it is important to contact an eye care professional immediately if you see
a sudden or gradual increase in the number of floaters and/or light flashes,
or a dark curtain over the field of vision.
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The NEI supported The Silicone Study, a nationwide clinical
trial that compared the use of silicone oil with long-acting intraocular
gas for repairing a retinal detachment caused by proliferative vitreoretinopathy
(PVR). With PVR, cells grow on the surface of the retina causing it to detach.
This is a serious complication that sometimes follows retinal detachment
surgery and is difficult to treat. The results indicate that both treatments
are effective and give the surgeons more options for treating these difficult
cases.
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ational Eye Institute (NEI)
National Marfan Foundation
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