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Retinal detachment

Retinal detachment: symptoms

The following complaints may be associated with retinal detachment:

  • “Floaters”: turbidities in the vitreous body which can manifest themselves as spiders, dots, strips or spots
  • Flashing lights as if a fluorescent light is on the blink
  • Failure of the visual field: an initial dark spot in the corner of the eye gradually expands
  • Reduced vision: retinal detachment can cause vision to disappear, either gradually or very quickly. First you’ll notice a dark spot in at the corner of the eye
  • When also the centre of the retina (macula or yellow spot) has become detached, sharp vision disappears.

The different steps in a retinal detachment

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First step: vitreous detachment

Initially the vitreous humor is attached to the retina and fills the entire posterior chamber of the eye. With age, the composition of the vitreous humor changes. It shrinks slightly and the gelatinous substance or vitreum becomes more liquid. As a result, the vitreous bag will suddenly separate from the retina and a space is created between the retina and the vitreous humor. We call that vitreous detachment. This space will fill with water. During this process, impurities also develop in the vitreous humor which will be perceived by the patient as black spots, "mouches volantes" or floaters. These floaters can be experienced as very disturbing. They will mainly be seen in bright light, looking at the blue sky or looking at a white wall.

Sometimes a vitreous detachment can cause bleeding or a retinal tear.

This vast majority of patients with a vitreous detachment remain at this stage and will not develop a retinal tear or retinal detachment. However, an extensive examination of the retina is always necessary to rule this out.

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Second step: Retinal tear

The detachment of the vitreous is a relatively normal phenomenon, but sometimes the posterior vitreous membrane is tighter than usual in places. This creates one or more tears in the retina during the release of the vitreous humor; a retinal tear. These cracks are dangerous and must always be treated by laser. An untreated tear can lead to a retinal detachment.

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Third step: Retinal detachment

When there is a retinal tear, water can come from the posterior chamber of the eye through the hole under the retina. A retinal detachment or retinal detachment occurs. The detached part of the retina can no longer function properly because it is loose. The patient will begin to see a dark blurry spot, usually starting at the edges of the field of vision. Here, rapid treatment is always required to save the eye.

The various degrees of retinal detachment

  • Peripheral detachment
  • Detachment with a loose macula
  • An older detachment
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Retinal detachment treatment: retinopexy

When it comes to a new and small retinal detachment, an external and less invasive procedure can be performed. The choice of this technique is only possible if the detachment is caused by a single small tear in the top part of the retina. The crack will be closed via cryotherapy (= freezing). Then a gas bubble is injected to put the retina back in place.

Retinal detachment treatment: scleral buckling

Conventional retinal ablation surgery (external procedure):
This operation is mainly used in young patients. A silicone band will be placed around the eye. The purpose of this operation is to reduce the traction forces of the vitreous humor on the retina by means of an elastic plastic band around the eye. For example, the holes that caused the retinal detachment will close and the retina will put itself back on its plate.

Retinal detachment treatment: vitrectomy

Vitrectomy is the most commonly performed retinal detachment operation. This technique will be chosen when an external procedure is not indicated. (eg. with cloudy vitreous humor, with too many or too large cracks). The first step of the vitrectomy is to make 3 microscopic openings in the sclera (= white part) of the eye. Then instruments will be brought in through these openings. The infusion with water is applied to the first opening. This way, the eye will always keep its shape during the operation. The endo light will be brought in through the second opening so that everything becomes visible. The vitrectoma is inserted through the third opening. This vitrectoma is a small tube that cuts and aspirates microscopic particles from the vitreous humor. The removed vitreous humor is replaced by clear water. The retina will be reconstructed via heavy fluids and the tear will be closed with a laser. To keep the retina in place until healing has occurred, a gas bubble or silicone oil will be applied to the eye. The gas bubble will gradually disappear from the eye and you will be able to see better after about two weeks. While gas is present in the eye, do not travel by plane or go to high altitudes (mountains). The silicone oil will need to be surgically removed again after a period of a few weeks to months.

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