Treatment of Retinal Detachment
The primary treatment for retinal detachment is surgical intervention, with the specific approach depending on the type of detachment, with options including laser photocoagulation, cryotherapy, scleral buckle, vitrectomy, or a combination of these techniques. 1, 2
Types of Retinal Detachment and Diagnosis
- Rhegmatogenous retinal detachment (RRD) is the most common type, resulting from retinal breaks caused by vitreoretinal traction 3
- Patients typically present with symptoms including light flashes, floaters, peripheral visual field loss, and blurred vision 3, 4
- Diagnosis requires thorough peripheral fundus examination using scleral depression, with presence of pigmented cells in the vitreous suggesting a retinal break 2
- When fundoscopic examination isn't possible due to media opacity, B-scan ultrasonography should be performed to detect retinal tears or detachment 1, 5
Treatment Approaches Based on Type of Retinal Break
Symptomatic Retinal Breaks
- Symptomatic horseshoe tears (associated with new-onset PVD, flashes, and floaters) require immediate treatment 1
- At least 50% of untreated symptomatic retinal breaks with persistent vitreoretinal traction will lead to clinical retinal detachment 1
- Treatment by prompt creation of a chorioretinal adhesion around these tears reduces the risk of retinal detachment to less than 5% 1
Asymptomatic Retinal Breaks
- Asymptomatic atrophic or operculated retinal breaks rarely need treatment 1, 6
- Approximately 5% of eyes with asymptomatic horseshoe tears progress to retinal detachment 1
- Generally, atrophic round holes within lattice lesions with minimal subretinal fluid and no PVD do not require treatment 1
Surgical Management Options
For Retinal Breaks Without Detachment
- Laser photocoagulation or cryotherapy to create a chorioretinal adhesion around the break 1, 2
- Treatment should extend to the ora serrata if the tear cannot be surrounded 1
- The most common cause of failure is inadequate treatment, particularly along the anterior border 1
For Retinal Detachment
- Scleral buckle, vitrectomy, or a combination of both techniques 7, 4
- Anatomical success rates are in the range of 85% to 90% 4
- Early intervention is critical as the rate of successful reattachment is higher and visual results are better when repaired before the detachment involves the macula 1
Follow-up Care
- First follow-up visit at 1-2 weeks after treatment 1
- Indirect ophthalmoscopy and scleral depression at 2-6 weeks to determine the adequacy of the chorioretinal scar 1
- Additional treatment should be administered if the tear and accompanying subretinal fluid are not completely surrounded by the chorioretinal scar 1
- Between 5% and 14% of patients found to have an initial retinal break will develop additional breaks during long-term follow-up 1
Special Considerations
- Younger myopic patients with lattice degeneration and holes need regular follow-up visits to monitor for subclinical retinal detachments 1
- Treatment should be considered if subclinical detachments progress in size 1
- Patients presenting with acute posterior vitreous detachment (PVD) and no retinal breaks have approximately 2% chance of developing retinal breaks in the following weeks 1
- Selected patients with vitreous pigment, hemorrhage, or visible vitreoretinal traction should return for a second examination within 6 weeks following symptom onset 1
Patient Education
- All patients at increased risk of retinal detachment should be instructed to notify their ophthalmologist immediately if they experience changes in symptoms (increased floaters, visual field loss, decreased acuity) 1
- Patient education about symptoms improves the likelihood of prompt reporting, enhancing the opportunity for successful treatment and better visual outcomes 1
- Patients who undergo refractive surgery to reduce myopia should be informed that they remain at risk of RRD despite reduction of their refractive error 1