From the Guidelines
Retinal detachment is a medical emergency that requires immediate attention, and treatment should be initiated as soon as possible to prevent permanent vision loss. The symptoms of retinal detachment include sudden flashes of light, new floaters, a shadow or curtain across your vision, or sudden vision loss 1. This condition occurs when the retina separates from the back of the eye, disrupting the blood supply and potentially leading to permanent vision loss if not treated promptly.
Causes and Risk Factors
The precursors to retinal detachment are posterior vitreous detachment (PVD), asymptomatic retinal breaks, symptomatic retinal breaks, lattice degeneration, and cystic and zonular traction retinal tufts 1. People with high myopia (severe nearsightedness), previous eye surgery, eye trauma, or family history of retinal detachment are at higher risk.
Treatment Options
Treatment depends on the severity but typically involves surgery, which may include:
- Laser photocoagulation
- Cryopexy
- Pneumatic retinopexy
- Scleral buckling
- Vitrectomy 1 The goal of retinal detachment treatment is to allow patients to maintain their abilities to read, work, drive, care for themselves, and maintain their quality of life. Recovery after surgery requires following specific positioning instructions, using prescribed eye drops (typically antibiotic and anti-inflammatory drops like moxifloxacin and prednisolone), and avoiding strenuous activities for several weeks 1.
Importance of Early Diagnosis and Treatment
An early diagnosis of an retinal detachment is also important because the rate of successful reattachment is higher and the visual results are better when repaired early and especially before the retinal detachment involves the macula 1. Prompt intervention is indicated if there is a tear seen on ultrasonography and the vitreous cavity precludes a view 1. The urgency for treatment stems from the fact that photoreceptor cells in the detached retina begin to die within hours to days without proper blood supply, making time-to-treatment a critical factor in preserving vision.
Prophylactic Treatment
The prophylactic treatment of high-risk breaks usually prevents retinal detachment 1. However, there is limited evidence to support prophylactic therapy for asymptomatic retinal breaks 1. Patients with symptoms of possible or suspected PVD or retinal detachment and related disorders should be examined as soon as is feasible by an ophthalmologist skilled in binocular indirect ophthalmoscopy and supplementary techniques 1.
From the Research
Symptoms of Retinal Detachment (RD)
- Retinal detachment is an ophthalmologic emergency that requires immediate medical attention as it can potentially lead to permanent vision loss 2
- Symptoms may include vision loss, which can be partial or total, and may occur suddenly or gradually
- Other symptoms may include floaters, flashes of light, or a shadow or curtain descending over the field of vision
Treatment Options for Retinal Detachment (RD)
- The gold standard for diagnosing retinal detachment is dilated funduscopic exam, but when this exam is not feasible, ocular ultrasound provides a readily available and effective alternative 2
- Treatment options include:
- Pneumatic retinopexy: a procedure where a gas bubble is injected into the eye to push the retina back into place 3
- Scleral buckling: a surgical procedure where a flexible band is placed around the eye to push the retina back into place 3, 4
- Vitrectomy: a surgical procedure where the vitreous gel is removed from the eye and replaced with a gas bubble to push the retina back into place 3, 4
- The choice of treatment depends on the type and severity of the retinal detachment, as well as the patient's overall health and medical history
- In some cases, a combination of treatments may be used, such as scleral buckling and pneumatic retinopexy 5
Outcomes and Complications of Treatment
- The outcomes of treatment for retinal detachment can vary depending on the type and severity of the detachment, as well as the patient's overall health and medical history
- Complications of treatment can include cataract formation, glaucoma, and retinal redetachment 3, 5
- The success rate of treatment can also vary, with some studies reporting high rates of anatomical reattachment and visual recovery 3, 6, 5