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Retinal detachment: treatment
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Retinal detachment is a serious condition that can lead to blindness if left untreated. The only thing that can save the eye is surgery.
What is retinal detachment?
Within the eye, the space between the lens and the back of the eye’s inner lining (retina) is filled with a jelly-like substance, the vitreous (body).
The vitreous plays an important role in the successive development of posterior vitreous detachment, a retinal tear and retinal detachment.
Usually, the process of retinal detachment follows the following course:
First step: Posterior vitreous detachment
Initially the vitreous body is attached to the retina and fills the entire posterior chamber of the eye. As we get older the composition of the vitreous changes. It shrinks somewhat and the jelly-like substance (= vitreum) becomes more liquid. As a result, the vitreous membrane may come away from the retina, creating a space between the retina and the vitreous body (= posterior vitreous detachment). The space left then fills up with water. During this process, impurities will end up in the vitreous which the patient will report as black spots or floaters. These floaters can be quite disconcerting. Patients will mainly notice them in strong light, while looking at a blue sky or a white wall. For the treatment of floaters please refer to the next page.
Sometimes vitreous detachment may cause bleeding or a retinal tear
The majority of patients however will not progress from the first stage and develop a retinal tear of retinal detachment. To exclude the latter two scenarios, an in-depth examination of the retina will be required however.
Second step: Retinal tear
Detachment of the vitreous body is a relatively normal phenomenon, but in some cases the posterior hyaloid membrane may be tighter than normal. As a result, one or more tears in the retina (= retinal tear(s)) may appear as the vitreous body becomes detached. These tears are dangerous and must always be treated by laser. A retinal tear that has not been seen to can lead to retinal detachment.
Third step: Retinal detachment
When the retina has torn, water from the posterior chamber of the eye can end up under the retina via the tear (=retinal detachment). The part of the retina that has become detached is no longer able to function properly because it has come away. Patients will notice a dark blurry spot, which usually starts on the perimeter of the visual field. If that occurs, speedy treatment is essential if the eye is to be saved.
The various degrees of retinal detachment
Detachment with a loose macula
An older detachment
Retinal detachment: symptoms
The following complaints may be associated with retinal detachment:
"With 15 retina surgeries a week, we have the requisite experience to lead you to the best possible result."
Retinal detachment: causes
Retinal detachment can occur at any age, but some people are at an increased risk.
The main causes are of that higher risk are:
Retinal detachment: treatment
To check whether symptoms are associated with an actual detachment, an eye fundus examination will be performed.
Posterior vitreous detachment treatment
In principle, no treatment is required. However, if cloudy vision or floaters are terribly bothersome, a vitrectomy may be worth considering. During this surgical procedure, the vitreous body is removed, eliminating the vitreous body’s tensile forces. (FOTO) Cf. vitreous detachment page.
Retinal tear treatment
Retinal tears that affect patients must be treated with laser beams (argon laser) to prevent retinal detachment later on. This laser treatment involves securing the retina to the back of the eye all around the tear so that no fluid can get under the retina via the retinal tear, causing the retina to come away.(FOTO)
Retinal detachment treatment
Retinal detachment requires extensive surgical treatment. There are different methods to treat a retinal detachment:
(external procedure): retinopexy
(external): cerclage Conventional ablatio retinae surgery (external procedure):
This surgery is mainly performed on young patients and involves placing a silicone band around the eye. The objective of this procedure is to reduce the tensile forces of the vitreous body on the retina by means of an elastic synthetic band around the eye. This will help the little holes that caused the retinal detachment to close so that the retina returns to the right position.
Vitreous body and retina surgery (vitrectomy) (internal procedure):
This is the most common procedure to fix a retinal detachment. It is used when an external procedure is not indicated (e.g. cloudy vitreous body, multiple or large tears). The first step in a vitrectomy is to create 3 microscopic incisions in the eye’s sclera (= white outer layer of the eyeball). These incisions are required for the surgeon’s instruments. Via the first incision, the eye is infused with water to ensure that it retains its shape during surgery. Next, the endolight is inserted via the second incision so that the surgeon can see everything clearly. The vitrectomy probe is inserted via the third incision. This probe is a tiny tube that cuts away and suctions microscopic particles of the vitreous. The vitreous that has been removed is replaced with clear water. The retina is put back in place using heavy liquids and the tear is sealed by laser. To keep the retina in place until the eye has fully healed, a gas bubble or silicone oil is injected into the eye. The gas bubble will gradually disappear of its own accord and after about two weeks you will be able to see more clearly again. As long as there is any gas left in the eye you are not allowed to fly or spend time at high altitudes (mountains). If silicone oil is used, the oil will have to be surgically removed after a number of weeks or months.
If the retinal detachment is recent and minor an external procedure and minimally invasive procedure can be performed. However, this technique is only suitable if detachment was caused by 1 single tiny tear in the upper part of the retina. The surgeon will seal the tear by means of cryotherapy (= freezing). Once the tear has been sealed, a gas bubble is injected to put the retina back into the right position.
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