Retinal Detachment Treatment in Delhi, India

Retinal detachment is a serious eye condition that occurs when the retina at the back of the eye pulls away from its normal position. As a result, it separates from the layer of blood vessels. It requires immediate medical attention. The longer it is ignored, the higher the chances of permanent damage to the diseased eye. It may also lead to vision loss from the affected eye.

Some important signs of being wary of are:

• The appearance of flashes and floaters
• Reduced vision

Contact an ophthalmologist immediately if any of these signs become evident.

Symptoms of Retinal Detachment

A detached retina can clinically present as:

• In peripheral vision, bright flashes of light can be seen.
• Overall blurry vision.
• Suddenly appearing, new floaters in the eye.
• Shadowing that appears similar to a curtain or shade across the vision range.
• Pain is usually absent in or around the eyes.
• Decreased peripheral vision.

Types of Retinal Detachment

Retinal detachment is of three types:

1. Rhegmatogenous: It is the most common type of retinal detachment caused by a tear or hole in the retina. The tear allows fluid to seep in and accumulate underneath the retina. Subsequently, the retina detaches, loses blood supply, and stops functioning. This leads to loss of vision.
2. Tractional: Tractional detachment occurs when the scar tissue grows on the retina's surface. This leads to the retina pulling away from the back of the eye. This type of detachment is commonly seen in people with poorly controlled diabetes and other medical conditions.
3. Exudative: When fluid accumulates beneath the retina without a tear or hole in it, the type of detachment is referred to as exudative detachment. This type may be caused by age-related macular degeneration, injury to the eye, tumours, or inflammatory disorders.

Causes of Retinal Detachment

The retina detaches from the eye due to a tear or hole. When the eye fluid leaks through it, the retina eventually detaches from the remaining part of the eye. This is the result of a condition termed posterior vitreous detachment. Retinal detachment occurs due to the following reasons:

• Trauma
• Extremely bad near-sightedness.
• Family history of retinal detachment.
• Tractional detachment.
• Exudative detachment.

Diagnosis of Retinal Detachment

Doctors record the patient's medical history and family history and perform a physical examination. The tests they may recommend are:

• Retinal examination: An instrument with a bright light and special lenses may be used to examine the back of the eye and the retina. A highly detailed view of the whole eye, such as retinal tears, holes, or detachments, is available with this device
• Ultrasound imaging: Ultrasound tests help evaluate the presence of blood leaks in the eye that may make it difficult to see the retina. Doctors examine both eyes to see if symptoms are present in both. If the tear has not been identified at the first consultation visit, another visit may be necessary for a few weeks to confirm that the eye has not developed a delayed tear

Treatment for Retinal Detachment

Multiple surgical approaches are available to repair retinal tears. Depending on the treatment required (retinal tear or detachment), the doctors shall discuss the procedure or combination of techniques to select the best treatment option for a specific case. Some of the treatment choices are:

• Retinal Tears: When a retina shows a tear or hole that has not progressed to detachment, it can be treated to prevent retinal detachment and preserve vision.
• Laser Surgery or Photocoagulation: A laser beam is directed into the eye, which causes burns around the retinal tear. This creates scarring. Consequently, the retina is welded to the underlying tissue.
• Freezing (Cryopexy): First, local anaesthesia is injected to numb the eye. This is followed by applying a freezing probe to the eye's outer surface over the tear. This causes a scar that secures the retina to the eyewall.

Both these procedures do not require hospitalisation. Avoiding outdoor activities for a couple of weeks can help with better recovery

Surgery for Retinal Detachment

The detached retina requires surgery to repair within days of diagnosis to prevent loss of vision. The surgical approach is determined based on the severity of the detachment.

• Injecting air or gas into the eye: Pneumatic retinopexy involves the injection of a bubble of air or gas into the centre of the eye. If positioned correctly, the bubble will push the part of the torn retina against the wall of the eye. This prevents the flow of fluid into the space available behind the retina. Cryopexy may also help repair the retinal tear. The accumulated fluid resorbs by itself. Subsequently, the retina adheres to the wall of the eye.
• Indenting the surface of the eye: This procedure is called scleral buckling. It involves sewing (suturing) a piece of silicone material to the white part of the eye, called the sclera, over the affected area. This procedure indents the eyewall and helps relieve some of the pressure caused by the tugging on the retina. Several tears or an extensive detachment may form a scleral buckle. This buckle encircles the whole eye like a belt. The buckle is positioned such that it doesn't block the vision and remains in place forever.
• Draining and replacing the fluid: The vitrectomy procedure removes the vitreous and any tissue tugging on the retina. This procedure involves injecting gas, air, or silicone oil into the vitreous space to flatten the retina. The injected substance eventually resorbs, and the space thus created gets filled with body fluid.

Complications of Retinal Detachment

Retinal detachment leads to loss of vision, which can be prevented with timely treatment. However, surgical procedures carry some risks. A detached retina can cause:

• Bleeding
• Infection
• Glaucoma - Increased pressure within the eye.
• Cataract - Fogging of the lens of the eye.

Risk Factors of Retinal Detachment

The following factors help increase the risk of retinal detachment:

• Age: common in people over the age of 50.
• Family history of retinal detachment.
• History of retinal detachment in one eye.
• Myopia - Extreme near-sightedness.
• History of eye surgery, such as cataract removal, severe eye injury, or other eye disorders, such as retinoschisis, uveitis, or thinning of the peripheral retina (lattice degeneration).

Prognosis of Retinal Detachment

The prognosis after the treatment of retinal detachment depends upon the location and extent of the detachment. Early detection and treatment significantly affect the prognosis. If the macula is not damaged, the outlook with treatment could be too good. Successful surgery may not always restore vision fully. One must remember that not all detachments can be repaired.

Review

Reviewed by Dr. Nikhil Pal - Principal Consultant, Eye Care / Ophthalmology.