From the Guidelines
For a two-day-old partial retinal detachment, immediate referral to a retinal specialist for urgent surgical intervention is crucial, as prompt intervention is indicated if there is a tear seen on ultrasonography and the vitreous cavity precludes a view 1. The primary treatment is typically a vitrectomy with laser photocoagulation or cryotherapy, followed by gas or silicone oil tamponade. Some key points to consider in the management of partial retinal detachment include:
- The procedure should be performed within 24-72 hours of diagnosis to maximize visual outcomes, as vision loss occurring secondary to macula-involving retinal detachment can be significant 1.
- Pre-operative measures may include strict bed rest with the affected eye positioned upward and cycloplegic eye drops (e.g., atropine 1% twice daily) to reduce pain and prevent further traction on the retina.
- Post-operatively, the patient will need to maintain a specific head position for several days to weeks, depending on the location of the detachment and the type of tamponade used.
- Antibiotic and steroid eye drops (e.g., prednisolone acetate 1% four times daily for 1-2 weeks) are typically prescribed to prevent infection and reduce inflammation, as complications of retinal detachment and its treatment can be significant 1. It is essential to note that patients with symptoms of possible or suspected retinal detachment should be examined as soon as is feasible by an ophthalmologist skilled in binocular indirect ophthalmoscopy and supplementary techniques, and patients with retinal breaks or detachments should be treated by an ophthalmologist with experience in the management of these conditions 1.
From the Research
Treatment Options for Retinal Detachment
The treatment for a 2-day-old partial retinal detachment typically involves surgical techniques, including:
- Vitrectomy: a procedure where the vitreous gel is removed from the eye and replaced with a gas or oil to help the retina reattach 2, 3, 4, 5
- Scleral buckling: a procedure where a flexible band is placed around the eye to push the retina back into place 3, 4, 5
- Pneumatic retinopexy: a procedure where a gas bubble is injected into the eye to help the retina reattach 2
Factors Influencing Treatment Choice
The choice of surgical procedure depends on various factors, including:
- Lens status: patients with a clear lens may be considered for scleral buckling as an alternative to vitrectomy 4
- Number of retinal breaks: the extent and location of the retinal breaks can influence the choice of surgical procedure 4, 5
- Extent of the detachment: the size and location of the detachment can affect the choice of treatment 4, 5
- Presence of proliferative vitreoretinopathy (PVR): the presence of PVR can influence the choice of surgical procedure and the use of adjunctive treatments 3, 4
Postoperative Complications
Common postoperative complications include:
- Cystoid macular edema: a condition where the macula becomes swollen due to fluid accumulation 2, 3
- Epiretinal membrane formation: a condition where a layer of scar tissue forms on the surface of the retina 2, 3
- Macular folds: a condition where the macula becomes wrinkled or folded due to the detachment 2
- Re-detachment: the retina can re-detach after surgery, which can affect the outcome 3, 5