As we age the vitreous (jelly like substance) begins to liquefy and pull away from the retina with the help of gravity. The Vitreous is attached to the retina in several places. When the vitreous tugs on the retina the brain interprets it as a flashing light. If the vitreous is strongly attached, a strong tug can pull a tear in the retina. If the vitreous pulls away from an area overlying a vessel, the patient may see little black specks or strings floating around. This could be blood that escaped when the vitreous pulled on the vessel. The bleeding (hemorrhage) could be excessive enough to fill the eye and completely block the vision and the doctor’s view. When a hole or tear is pulled there is the risk of fluid getting in the hole that was caused by the vitreous pulling away and separating the retina from the wall of the eye. This is called a Retina Detachment. If caught early, laser treatment or Cryotherapy (freezing treatment) can be put around the hole to seal it down and prevent retinal detachment. If the doctor is unable to view the retina due to excessive hemorrhage, an ultrasound test will be ordered. This will detect if there is a retinal detachment that requires surgery. If there is no retinal detachment, the doctor will allow 2 to 3 months for the hemorrhage to dissolve so that he can see the hole or tear and place treatment around it. Until that day the ultrasounds will be performed every 1 to 3 weeks to screen for retinal detachment.
Should Retinal Detachment occur, in most cases surgery will be required to repair it. One of three surgical procedures will be performed. The first one is called a Vitrectomy. During this surgery the Doctor will make two holes in the eye, one for a light pipe, one for surgical instruments. The Vitreous (jelly like substance) is broken up and suctioned out of the eye. This allows the surgeon to get to the back of the eye and make the needed repairs. Gas or Silicone Oil is placed in the eye to be used as a brace against the retina to hold it flat while it heals. Laser or Cryotherapy is placed around or under the hole or tear to seal it down. If Gas is placed in the eye, the patient will be required to assume a face down position, 24 hours a day, for 1 to 2 weeks after surgery. This places the gas bubble against the back of the eye, flattening the retina, and aids in healing. The gas will slowly dissolve over 6 to 8 weeks and be replaced with intra ocular eye fluid. If Silicone Oil is placed in the eye the patient will be required to assume a face down position for 1 to 2 nights following surgery. The Silicone Oil will remain in the eye until the surgeon feels the patient is no longer at risk of re-detaching if the oil is surgically removed.
The second surgical procedure the doctor may choose to perform is called a Scleral Buckle. In this procedure (the most traditional of the three), the surgeon treats the retina tear with cryotherapy then places a piece of silicone plastic strap or sponge over the site of the tear. This silicone plastic strap is stitched onto the outside wall of the eye and is left there permanently. It pushes the sclera (white, outside wall of the eye) in toward the retinal tear and holds the retina against the sclera until scarring from the cryotherapy seals the tear.
The third procedure the doctor may recommend is called Pneumatic Retinopexy. This procedure is usually performed in the office and only on very early, shallow retinal detachments. Cryotherapy or laser treatment is performed to seal the retinal tear or hole. The surgeon injects a gas bubble inside the vitreous cavity of the eye with a needle. The patient is instructed to keep his or her head in a specific position so that the gas bubble pushes the retina against the back wall of the eye to seal the retinal tear. The patient is asked to remain in this position for a period of time until the retinal tear is sealed against the back wall of the eye. The gas bubble in the vitreous cavity of the eye expands for several days and takes two to six weeks to disappear. During this time, airplane travel or travel to a higher or lower elevation must be avoided because high altitudes can result in an expansion of the gas and increase the pressure in the eye causing irreparable damage to the optic nerve.
In most cases of Retinal Detachment, there is a 90 to 95% chance of successfully reattaching the retina with one operation. With additional surgeries, more than 95% of detached retinas can be reattached. However, successful reattachment does not necessarily mean restored vision. The return of good vision after the surgery depends on whether, and for how long, the macula was detached prior to surgery. If the macula was detached, vision rarely returns to normal. Still, if the retina is successfully reattached, vision usually improves. The best vision may not occur for many months after surgery. In some cases, even if the macula was still attached before the surgery, and even if the surgery results in successful reattachment of the retina, some vision may be lost.