What is the treatment for retinal detachment?

Treatment of Retinal Detachment

The primary treatment for retinal detachment is surgical intervention, with the specific approach determined by the type and extent of detachment—options include laser photocoagulation, cryotherapy, scleral buckle, vitrectomy, or a combination of these techniques. 1

Immediate Management Algorithm

For Symptomatic Retinal Tears (Pre-Detachment)

• Symptomatic horseshoe tears require immediate treatment because at least 50% of untreated symptomatic retinal breaks with persistent vitreoretinal traction will progress to clinical retinal detachment 1
• Prompt creation of a chorioretinal adhesion around these tears using laser photocoagulation or cryotherapy reduces the risk of retinal detachment to less than 5% 1
• Treatment should extend to the ora serrata if the tear cannot be completely surrounded 1

For Established Retinal Detachment

• Early intervention is critical because the rate of successful reattachment is higher and visual results are better when repaired before the detachment involves the macula 1
• Surgical options include:
  • Scleral buckle for appropriate cases 2, 3
  • Pars plana vitrectomy with tamponading agents 2
  • Combination approaches depending on complexity 1, 3
• Anatomical success rates exceed 85-90% with modern surgical techniques 3

Special Considerations by Detachment Type

Tractional Retinal Detachment (TRD)

• Immediate vitrectomy is indicated for any TRD threatening or involving the macula, with anatomical success rates over 90% 4
• Surgery should be performed expeditiously once TRD threatens the macula, as delays worsen prognosis and progressive vision loss occurs without intervention 4
• Macula-on detachments have dramatically better visual outcomes than macula-off detachments, emphasizing the critical importance of prompt treatment 4
• Avoid observation or anti-VEGF monotherapy as first-line treatment when vitrectomy is feasible, as this delays definitive treatment and worsens outcomes 4

Rhegmatogenous Retinal Detachment

• This is the most common type, resulting from retinal breaks caused by vitreoretinal traction 5, 6
• Treatment consists of identifying and sealing all retinal holes, relieving vitreoretinal traction, and preventing recurrence 2
• Vitrectomy is followed by lens opacification in more than 70% of cases, which should be discussed with patients 3

Diagnostic Workup Before Treatment

• Thorough peripheral fundus examination using scleral depression is essential for diagnosis 1
• When fundoscopic examination isn't possible due to media opacity, B-scan ultrasonography should be performed to detect retinal tears or detachment 1
• Presence of pigmented cells in the vitreous suggests a retinal break 1
• Wide-field photography may be helpful but does not replace careful ophthalmoscopy 1

Post-Treatment Follow-Up Protocol

• 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
• Between 5% and 14% of patients found to have an initial retinal break will develop additional breaks during long-term follow-up, necessitating continued surveillance 1
• Younger myopic patients with lattice degeneration and holes need regular follow-up visits to monitor for subclinical retinal detachments 1

Critical Timing Considerations

The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, preserving visual acuity. 3 This is the single most important factor determining visual prognosis 4. Patients with acute onset of flashes or floaters should be referred to an ophthalmologist on the same day that symptoms arise 5, 3.

Common Pitfalls to Avoid

• Do not delay treatment for symptomatic retinal tears or established detachments, as this significantly worsens visual outcomes 1, 4
• Do not rely solely on imaging without performing careful ophthalmoscopy with scleral depression 1
• Do not assume asymptomatic patients are safe—patients presenting with acute posterior vitreous detachment and no retinal breaks still have approximately 2% chance of developing retinal breaks in the following weeks 1
• Educate all at-risk patients to notify their ophthalmologist immediately if they experience changes in symptoms, as patient education improves the likelihood of prompt reporting and better visual outcomes 1